CURRICULUM
% v f T 'SPfc f~~^ T Ti T /^
NURSING
UNIVERSITY OF CALIFORNIA
AT LOS ANGELES
...
UNIVERSITY of CALIFOKM*
AT
LOS ANGELES
LIBRARY
STANDARD CURRICULUM
FOR
SCHOOLS OF NUBSIM
PREPARED BY
THE COMMITTEE ON EDUCATION
OF THE
NATIONAL LEAGUE OF NURSING EDUCATION
1915 to 1918
M. ADELAIDE NUTTING, Chairman
Teachers College
New York City
ISABEL M. STEWART, Secretary
Teachers College
New York City
ELLA PHILLIPS CRANDALL
156 Fifth Avenue
New York City
MARY S. GARDNER
Providence District Nursing
Association, Providence, R. I.
ANNIE W. GOODRICH
Teachers College
New York City
MARY C. WHEELER
Illinois Training School
Chicago, 111.
MARY M. RIDDLE
Newton Hospital
Newton, Mass.
ELSIE M. LAWLER
Johns Hopkins Hospital
Baltimore, Md.
MARY BEARD
Boston Inst. Dist. Nursing Asso.
Boston, Mass.
LOUISE M. POWELL
University Hospital
Minneapolis, Minn.
EDNA C. FOLEY
830 Monroe Building
Chicago, 111.
ELIZABETH BURGESS
State Educational Department
Albany, N. Y.
MARY W. MCKECHNIE
420 West 118th Street
New York City
SUSAN E. TRACY
818 Center Street
Jamaica Plains, Mass.
Copies may be secured from the secretary. Price $1.00 with postage in addition
The preparation of this curriculum was made possible by a gift from Mrs.
Helen Hartley Jenkins to meet the initial expenses.
40154
COPYRIGHT 1919
BY THE COMMITTEE ON EDUCATION
OP THE
NATIONAL LEAGUE OF NURSING EDUCATION
COMPOSED AND PRINTED AT THB
WAVERLY PRKS8
Br TUB WlLUAMB A WlI.KINS CouPAWT
BALTIMORE, MD., U. 8. A.
TVPTl
N^l3s
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TABLE OF CONTENTS
f\
I. Introduction ...................................................... 5
II. Relation of Hospital and Training School Organization and Admin-
istration to the Curriculum .................................. 9
A. The General Purpose, Character and Standing of the Hospital 10
B. Form and Functions of Training School Control .............. 11
C. Type and Capacity of Hospital .............................. 12
D. Financial Resources .......................................... 15
E. The Teaching Field (Range, Variety and Character of Services) 16
F. Conditions of Life and Work for Students (Ratio of Nurses to
<\ Patients, Hours of Duty, Housing and Living Conditions,
etc.) ....................................................... 18
G. The Administrative and Teaching Staff ..................... 22
H. Standards of Entrance to Schools of Nursing ................. 24
I. The Admission of Classes .................................... 27
^-. J. Standards and Methods of Good Teaching .................... 27
— - K. Teaching Equipment.4. ....................................... 30
C~) L. Records ..................................................... 31
*""~ M. University Affiliations ....................................... 32
N. References on Nursing Education and Teaching .............. 32
III. Course of Study.
A. Length of Course and General Division of Time ............. 35
B. General Scheme of Practical Instruction ...................... 35
C. General Scheme of Theoretical Instruction ................... 38
IV. Outline of Subjects.
A. Biological and Physical Sciences.
Anatomy and Physiology. . .-. .............................. 40
Elementary Bacteriology. . i- ................................ 45
J Applied Chemisty. . . : .................... : ................. 48
I B. Household Science.
Nutrition and Cookery. . . .................................. 53
Diet in Disease. .:. ......................................... 57
Hospital Housekeeping. k .* .................................. 58
Housekeeping Problems of Industrial Families.^ ............ 60
C. Prevention of Disease.
^ Personal Hygiene. . .•< ...................................... 64
Public Sanitation. . K ...................................... 67
p D. Treatment of Disease.
Drugs and Solutions. ..T. .................................. 70
Materia Medica and Therapeutics. ^ ........................ 72
Massage. .-. ................................................ 74
Special Therapeutics (including Occupation Therapy).. ^. . . 76
E. Nursing in Different Forms of Disease.
Elementary Nursing Principles and Methods. . T ............ 79
Elementary Bandaging. . * .................................. 84
Elements of Pathology. . .v .................................. 86
Nursing in Medical Diseases. .• ..... . ....................... 88
3
4 TABLE OF CONTENTS
Nursing in Surgical Diseases. . .• 91
Nursing in Communicable Diseases. . : 93
Nursing in Diseases of Infants and Children. .\ 96
Gynecological Nursing and Diseases of the Male Genito-
Urinary Tract...; 101
Orthopedic Nursing. 103
Obstetrical Nursing 105
Nursing in Diseases of the Eye, Ear, Nose and Throat 109
Nursing in Mental and Nervous Diseases. . i Ill
Nursing in Occupational, Skin and Venereal Diseases. . . K. . 115
Operating-room Technic 117
Emergency Nursing and First Aid. . .* 119
Special Disease Problems 121
F. Social and Professional Subjects
History of Nursing (including Ethical and Social Principles) 123
Elements of Psychology. 130
«_^. Principles of Ethics — ^. 131
Survey of the Nursing Field.1 137
Professional Problems . . . •. 140
Modern Social Conditions 143
G. Special Branches of Nursing.
Introduction to Institutional Work 147
Introduction to Private Nursing 149
Introduction to Public Health Nursing and Social Service. . 152
Introduction to Laboratory Work 155
Appendix I. Bibliography of Text and Reference Books Classified
According to Authors, with Names of Publishers, prices, etc 157
Appendix II. List of Inexpensive and Free Bulletins, Pamphlets, and
Reports for Use in Training Schools 167
Appendix III. List of Firms Supplying Equipment and Illustrative
Material for Training Schools 169
Appendix IV. Suggestions of Physical Exercises for Nurses in Training 171
Appendix V. Schemes of Practical Training for College Students Receiv-
ing Credit of Eight to Twelve Months for Satisfactory Previous
Work in Science 173
Appendix VI. Hour Schedules from Hospitals in which an Eight-hour
Day is in Operation 175
Appendix VII. Suggested Basin of Credit for Nursing Schools 177
INTRODUCTION
At the request of the Council of the National League of Nursing Education,
the Committee on Education undertook some little time ago the task of pre-
paring a curriculum which might serve as a guide to training schools struggling
to establish good standards of nursing education, and which might also repre-
sent to the public and to those who wish to study our work, a fair idea of what,
under our present system, we conceive to be an acceptable training for the
profession of nursing.
In sending out this curriculum, the Committee desires to emphasize afresh
its hope that there will be no failure to understand its purpose. It is not
offered as a "model" curriculum. There are many improvements which we
would gladly introduce if we could see any possibility of putting them into
effect at the present time. Moreover, the Committee is not urging the un-
qualified adoption of this curriculum in training schools generally. It realizes
that under the widely varying conditions existing in hospitals at present, a
relative uniformity only is attainable or advisable. Schools laboring under
the handicap of long hours and insufficient teaching facilities would be unable
to do justice to the curriculum here outlined until more favorable conditions
could be established. A few schools with superior advantages and good leader-
ship have already, in certain respects, gone beyond these standards and it is
highly important that they should in no way relax their efforts, but should
lead in working out something better than anything we have reached as yet.
The purpose which the Committee has had in view, is to arrive at some
general agreement as to a desirable and workable standard whose main features
could be accepted by training schools of good standing throughout the country.
In this way it is hoped that we may be able to gradually overcome the wide
diversity of standards at present existing in schools of nursing, and supply a
basis for appraising the value of widely different systems of nursing training.
The work of the professional nurse is practically the same in all the states
of the union, and it would seem to be perfectly evident that the training which
is to guarantee a certain acceptable measure of competence, would need to
follow somewhat similar lines, whether the nurse is trained in California or
New York, and whether the training is given in a small or a large hospital.
The main difficulty is the lack of a clear understanding of what the function
of a modern nurse is, or what the purpose and scope of her training should be
The war is making us realize, what the public generally and the training schools
have been slow to recognize, that nursing is in a very special sense a national
service, and that the training of the nurse is a matter of vital concern not only
to her hospital and to herself, but to the country at large. It is not enough
that she should serve the needs of a single institution or of a limited group
of people. She must be ready to serve the whole community and to meet
conditions as she finds them in many different kinds of communities.
It is becoming clearly evident, that if she is to do this effectively, we must
revise many of our old ideas about the nurses' training. The value of her
service is being recognized in so many new fields of work, and the character of
that service is changing so rapidly, that the preparation which was considered
quite adequate a few years ago is no longer sufficient.
5
0 INTRODUCTION
The steady expansion into new and exacting fields of effort, .s continually
revealing to us both the strength and the weakness of our methods of training.
The strength lies in the character of the actual practical work, which in most
training schools is sincere and thorough and performed in a spirit of devo-
tion, zeal and self-forgetfulness which is remarkable. Teachers and students
alike are imbued with this spirit. It has become a part of the history and
tradition of nursing and forms an almost invaluable contribution to the world's
service. The weakness lies in the over-emphasis placed upon the practical
aspects of the training and the consequent neglect of the theoretical founda-
tion on which really good practical work must always be built.
It is now recognized that if the sick patient is to have the most skilful and
competent kind of nursing care, and if nurses are to keep pace with the ad-
vances of modern medicine, they must have something more than a mere deft-
ness in precise manipulations and the scattered fragments of scientific knowl-
edge which are all that can usually be given in the scant time allowed by most
hospital training schools. The development of more highly complicated pro-
cedures in diagnosis and treatment, and the increased emphasis especially on
dietetic, hygienic, occupational and mental factors in the treatment of dis-
ease, make it necessary that the nurse should assume an increasing measure
of responsibility in the care and treatment of the patient. To safeguard her
in those responsible duties, she must have a large measure of scientific knowl-
edge and she must be more highly trained both in observation and in judgment.
A distinct limitation in the ordinary training is that it deals only or mainly
with disease, neglecting almost entirely the preventive and educational factors
which are such an essential element in the many new branches of public health
work, such as school and visiting nursing, infant welfare, industrial welfare
and hospital social service. Similarly the physical causes and evidences of
disease have been recognized as important, but the social and economic con-
ditions which He at the root of so many of our disease problems, have usually
been over-looked in the course of training. This knowledge is fundamental,
particularly in the newer branches of nursing, and the lack of it is a distinct
handicap to the nurse in her work.
In positions of leadership especially, we are suffering for the lack of well-
trained women. Hospitals and training schools are looking everywhere for
competent women to undertake the important duties of superintendents,
supervisors, teachers and technical experts in many different departments.
Unless the hospital itself selects good women and gives them a broad sub-
stantial foundation to begin with, there is little hope that we will develop
many of the kind of leaders who are needed for our very responsible educational
and administrative work.
Nurses themselves have been the first to realize the necessity for a better
organized and more thorough course of instruction than is commonly given in
the averge training school, and they are beginning to insist that they be
given a kind of training more commensurate with the tasks which are laid
upon them. It is certain that we cannot command the continued interest of
intelligent and competent women in hospital and nursing work, unless we can
provide a course of study which compares more favorably with the courses
given in other technical and professional schools.
INTRODUCTION 7
The members of the Committee realize fully the difficulties of the hospital
and the training school staff in meeting all these new conditions, with the
many other perplexing and insistent problems which have to be faced. They
do not for one moment forget the invaluable services to nursing education
which have been given at great personal sacrifice or in spite of peculiar ob-
stacles, by our large body of devoted and untiring superintendents and
teachers, and by many physicians as well. Nor do they underestimate the
unique value of many splendid features in our system of training. They are
convinced, however, that the situation at present demands an unusual effort
and they are confident that training schools generally will do their utmost to
at least approximate these standards of nursing education which have been
agreed upon as reasonable and desirable. They believe that the public and
the pupil nurse are justified in expecting this effort from all hospital training
schools, but particularly from those claiming to rank as nursing schools of the
better class.
The Committee wishes to make it quite clear that while it believes all the
subjects suggested in the course of study are important, they are not all equally
important. It will be noted that several of the subjects outlined are recom-
mended only, and it is understood that they should not be introduced at the
sacrifice of the more fundamental subjects. In suggesting some elective sub-
jects, the Committee does not wish* to advocate specialization within the
general training, but only an opportunity for students to get a fair introduc-
tion to one of the fields of nursing in which they are specially interested.
The general feeling of most of those who have gone over the outlines is that
while the material is all necessary, and they would be unwilling to have any
of it eliminated, the time usually allotted is too short to cover the ground in a
really thorough way. The Committee has decided to leave the material as it
is, with the suggestion that the hours should be increased wherever possible,
and that instructors should use their own discretion in choosing what points
should be particularly stressed and which should be omitted or treated less
thoroughly.
The work has proven much more difficult than at first anticipated, especially
since the members of the Committee are all women already fully occupied
with exacting professional duties which the pressing problems of the last year
or two have greatly increased. After the general scheme was decided upon
by the Committee and approved by the League of Nursing Education, the
various subjects were assigned to members specially qualified in those
branches, who proceeded with such help and advice as they were able to
secure, to work out the outlines according to a general form. Each outline
was then multigraphed and copies were submitted to a number of representa-
tive training school superintendents, teachers, supervisors and public health
nurses throughout the country for detailed criticisms and suggestions. Over
one hundred members have assisted in this work. The outlines were then
collected, the suggestions compiled and new outlines made out which were
again, in several cases, referred back to various members 'before being finally
approved. Opinions differed frequently and in such cases the majority
opinion was accepted. A great many helpful suggestions were received, and
8 INTRODUCTION
the Committee takes this opportunity of again thanking all those friends who
so generously assisted in the work.
There is little doubt that the next few years will see many new developments
along nursing lines. It is the intention of the Committee to keep the curricu-
lum up-to-date by frequent revision, and to supplement the material in this
first edition from time to time. The Committee begs the assistance of all
those who are interested in the better training of nurses, in this work. We
should be particularly grateful to have any suggestions for additions or cor-
rections which should be made in the next edition.
THE RELATION OF HOSPITAL AND TRAINING
SCHOOL ORGANIZATION AND ADMINIS-
TRATION TO THE CURRICULUM
In working out a curriculum which aims to cover the ground required in the
training of nurses in so satisfactory a way that it can be accepted as a standard
and adopted generally in training schools, certain important facts must be
kept steadily in mind. These are, first, that the education of nurses is notv
carried on in the ordinary type of school, but in hospitals and under a well-
established system which requires that the practical training shall be obtained
through student service in the various departments. This practical training *
•'ndeed, is considered of such importance in the general scheme as to occupy
almost the entire time and energy of the student; in all schools of which we
have knowledge more than nine-tenths of the student's time throughout the
three years being devoted to practical work. This means that the theory,,'
essential and indispensable as it is, in reality occupies everywhere a relatively'
small place in respect to time in the curriculum. It means also that the con-
ditions in the hospital under which the teaching and training are conducted and
under which the students live and work, are decisive factors in the situation.
A curriculum does not operate itself. It is dependent upon persons and
conditions to give it life. No matter how admirably planned, it can only be
made truly effective in the education of the nurse if the hospital in which it is
to be carried out is of proper character and standing, and provides in its clinical
resources, teaching facilities and administrative policy, a suitable field for the
training of nurses. It has seemed necessary, therefore, at the outset, to try
to show what the general conditions and main requirements in hospitals should
be in order to ensure the satisfactory working out of a good curriculum.
This is a peculiarly difficult thing to do, because of the vastness and com-
plexity of the hospital field. There are about as many types of hospitals as
there are specialties in medicine. They exhibit extreme variation in purpose,
scope of work, size, and also in form of administration, ranging from that
exercised by municipal authorities or responsible bodies of trustees to that of
commercial stock companies or of individual enterprise. How shall we judge
of the ability of any one of these hospitals to provide a suitable field for the
training of nurses, or of its fitness to undertake that important task? What
standards and tests can we apply? For it is evident that many hospitals are
unable to provide for the most fundamental requirements in any form of
worthy educational work.
The standards which the Committee has accepted as desirable and here
presents in outline are those which have been gradually developed through
the experience and experiment of nurses who have been long engaged in
hospital and training school work, and in serious and continuous study of the
administrative and educational problems involved. In the course of years
certain conditions and requirements have been found to be essential to the
conduct of a good and sound system of training school work. These condi-
tions which have so important a bearing upon the situation, are found through-
9
10 HOSPITAL AND TRAINING SCHOOL STANDARDS
out the entire structure of hospital life, from foundation and purpose to inti-
mate daily conduct of affairs. They may in the main be summed up in a
general way under the following headings:
A. The General Purpose, Character and Standing of the Hospital.
B. Form and Functions of Training School Control.
C. Type and Capacity of Hospital.
D. Financial Resources.
E. The Teaching Field (Range, Variety and Character of Services).
F. Conditions of Life and Work for Students. (Ratio of Nurses to Patients,
Hours of Duty. Housing and Living Conditions.) "
G. The Administrative and Teaching Staff.
H. Standards of Entrance to Schools of Nursing.
I. The Admission of Classes,
J. Standards and Methods of Good Teaching.
K. Teaching Equipment.
L. Records.
M. University Affiliations.
A. THE GENERAL PURPOSE, CHARACTER AND STANDING OF THE
HOSPITAL
The first and one of the most fundamental requirements is that the hospital
shall be of good standing in the community, that it shall be under the general
direction of a responsible body of persons, trustees, directors, or managers of
such weight and influence &* to establish beyond question, the purpose, dignity
and stability of the institution, and to afford guarantees to the public, and to
prospective students and their families in particular, that it is a suitable place
to which to invite young women to enter for serious professional training. In
other words it must show that it is both able and ready to meet its obligations.
The character and standing of a hospital in any community must have a
direct bearing upon the kind of teaching which it will offer. A hospital of
established reputation will select with great care its officers and staff, physi-
cians, nurses, and all others concerned in the care of the sick, and will exact
from them a high quality of work, and single-minded devotion to the interests
and welfare of the patients. If it does not its reputation cannot be maintained.
The standards of its own work will be projected into its teaching throughout,
and its teaching will be of two kinds, — the conscious, deliberate and formal, and
the unconscious and incidental. Not more surely by what the student is told
ought to be done, than by what she sees done daily, will her ideals in work be
shaped. That hospital, then, in which the teaching and training of nurses can
best be carried on, is of a character which commands public confidence and
respect not only through the sound scientific nature of its work, but through
its ethical and altruistic purpose. Its whole life will be permeated by the best
spirit and traditions of medicine and nursing.
B. FORM AND FUNCTIONS OF TRAINING SCHOOL CONTROL
If the training school for nurses were simply the nursing staff of the hospital
and nothing more, then it could be placed upon the same basis as other hospital
HOSPITAL AND TRAINING SCHOOL STANDARDS 11
departments and dealt with accordingly. But in just such degree as the school
is something more than the nursing staff, outside and beyond it, do new and
different considerations enter into its management. Many elements which the
training school brings into hospital affairs do not naturally fall into any part
of the administrative scheme of an institution for the care of the sick. Quite
alien to the general purpose and usual activities of the hospital, are the special
and somewhat intricate problems of education to which the training school
must give constant time and attention, or fail in its work. And because these
problems are different, dealing with matters outside of hospitals which must
be viewed from other angles besides those looking to efficient hospital adminis-
tration, it is essential that there should be some body of persons who are very
specially concerned with them. A good many hospitals are now providing for
this need by the appointment of training school committees, and it is the
opinion of almost all training school superintendents who have carried on their
work with and without such committees, that they are an almost indispensable
factor in a good organization.
The composition of such a body varies in different institutions, but it is
suggested that a good working committee appointed from the trustees of the
hospital might be composed of five persons, which should include two Trustees,
a member of the Medical Board, the Superintendent of the Hospital, and the
Superintendent of the Training School. Such a committee would usually be
greatly strengthened by the addition of some one engaged in educational work,
such as the Superintendent of Public Schools, or the Dean, or Director of a
good College, Normal, or Technical School. In connection with large city
hospitals, into the government of which city politics sometimes enter, a
separate board of women managers has been found to be a great support and
protection to the training school.
The functions of these committees would naturally vary under different
conditions, but in the main they would consist in studying the needs of the
school as an educational institution not purely concerned with the temporary
service of the hospital, but with the permanent service of the public, and in
establishing such equitable relationships between the hospital and training
school, and such conditions of student life and work as will bring this result.
They should see that suitable requirements for admission are established and
maintained; that sound educational standards, for both practical and theo-
retical work prevail; that there is a properly qualified administrative and
teaching staff; that it is supplied with adequate school equipment and teach-
ing material; and that proper regulations are made about such matters as
tuition fees, loan funds, and scholarships.
Since these are all fundamentals which are well recognized in every school,
it is certain that ways and means must be found of providing them. It will
therefore be the function of the Committee to prepare a budget, and to secure
adequate appropriations from the hospital and from other sources, to place the
school upon this dignified, secure and stable basis, and to ensure it that inde-
pendence in its work and freedom for proper growth and development which
are characteristics of any good educational system and which a satisfactory
financial status alone can give. The securing and distribution of funds for the
maintenance of the school may be one of the most important functions of a
12 HOSPITAL AND TRAINING SCHOOL STANDARDS
training school committee in fostering good standards and ideals in the work
of the school.
C. TYPE AND CAPACITY OF HOSPITAL
The type of hospital in which a training school can best be established is that
which provides the requisite number of patients and variety of services of a
suitable character. It has long been accepted that the general hospital, in
which all the more common forms of medical and surgical diseases are treated
and which admits men and women patients, best answers to this description.
General hospitals under municipal government or private endowment or main-
tained by contributions are found in all large cities, in most moderate s zed
and in many small cities.
The actual number of beds and daily average of patients, within certain
specified limits, is of less importance than the variety and character of the
services. The very large municipal hospitals of from 600 beds up to 1000 or
1500, usually offer the richest possible field for training, in so far as numbers
and variety and character of services are concerned, and in the exceptional
opportunities afforded by their clinics and dispensaries. The great difficulty
here lies in securing enough expert supervisors, and qualified instructors, and
enough in the way of resources and conveniences to maintain a good quality of
work over such a vast area. The problem of training is difficult because of the
almost unwieldy dimensions of the training field, and of the enormous bulk of
work to be done. In such large city hospitals this problem may also some-
times be complicated by the fact that there may be a division, sometimes a
large one, of patients with chronic diseases providing little in the way of suit-
able opportunity for training, yet requiring, under the system, a definite place
in the general scheme of instruction. Granted, however, means to maintain
a sufficiently large staff of graduate nurses in addition to the student nursing
service, and a liberal and properly qualified staff of executive officers, super-
visors and teachers, a great municipal hospital affords a wonderful teaching
field.
On the other hand, very small hospitals, even when general in character,
have definite limitations not only in numbers of patients, and in range and
variety of disease, but also in equipment and facilities. The opportunities
they offer for observation and training and their resources are usually, in the
very nature of the case, too meagre and restricted to provide more than a
fraction of the required course of instruction in nursing. While these very
small hospitals are obviously unable, in most instances, to provide a satis-
factory field for the entire training of nurses, they are the class of institutions
frequently most needing the assistance, which a training school provides.
Their problem is a difficult one. Probably most of them could supply good
practical training in the care of patients suffering from a few of the more com-
mon forms of disease for a period, let us say, covering not more at the extreme
than 12 months. How to secure the necessary instruction in theory is, how-
ever, another question. There does not appear to be any other way to get the
elementary scientific groundwork required in nursing than to turn to the
visiting teacher, who might spend two days weekly in three not too widely
HOSPITAL AND TRAINING SCHOOL STANDARDS 13
separated hospitals, or to fall back upon the nearest high school for special
classes, or upon a combination of both, with assistance from local physicians.
The success of such plans would depend greatly upon the energy and initiative
of the head of the training school, and upon her ability to make the utmost
possible use of every available opportunity. It takes women of exceptionally
good professional training, experience and resourcefulness to bring forth
satisfactory results from a poor field.
Given well-trained assistance in the hospital, and the certainty of a good
quality of practical training, there appears to be no reason why at leas tone
year of prescribed ground could not be covered and the students passed on to
the larger schools to complete their training. Small schools should be as proud
of sending up their students to certain large hospitals for the final two years,
as preparatory schools are of sending theirs to colleges. The principle is the
same. The necessity of a uniform arrangement of subjects is clear, for the
larger school must know just what ground in theory and practice has already
been covered, and must require that certain well-defined work has been done.
Between these two extremes lie a large number of hospitals capable of pro-
viding excellent teaching fields. In the order of their capacity in this direction
they would stand about as follows : first, hospitals, general in character, and
under municipal or private government, with from 400 to 500 beds, and having
not only the four main services — medical, surgical, children's and obstetric —
but certain of the special branches, such as nervous and mental disorders,
contagious diseases, eye, ear, throat and nose, etc. These afford a practically
complete field for the training of nurses. There can be no question of their
ability under proper administration to conduct training schools of the very
highest character. Next would come hospitals of the same general type and
character, with from 150 to 200 beds, and a daily average of from 125 to 150
patients. These also provide excellent teaching fields.
While the smaller general hospitals can only meet the requirements and
obligations which the establishment of schools of nursing imposes on them by
acquiring suitable affiliations with other hospitals able to provide satisfactory
instruction and training in the branches of nursing in which they are deficient,
it is pretty generally agreed that unless such hospitals have a daily average of
about 50 patients and a fairly acute service, it is hardly possible for them to
maintain schools of nursing of the usually accepted standards. This appears
to be about the minimum, in so far as the number of patients is concerned, and
has been long accepted as such in England and various other countries, and by
the American Red Cross in this country. In the training of medical students,
the Council of Education of the American Medical Association urges that hos-
pitals, to be satisfactory for teaching purposes, should have a daily average of
not less than 200 patients who can be utilized for clinical teaching. (See
Journal American Medical Association, August 19, 1916, pages 601-607.)
There must be variations from these suggested standards in exceptional
institutions, and particularly in certain states and sections where hospitals
have developed slowly and are almost all quite small. They are all that is
available for training purposes in such localities, and obviously the standards
that are desirable in older communities where work is further advanced, cannot
and should not be applied to them at present.
14 HOSPITAL AND TRAINING SCHOOL STANDARDS
Special hospitals present a peculiar problem. Many of them can contribute
to the general scheme of training, and efforts should be made to utilize the
special opportunities they provide. Few, if any of them, are competent to
conduct schools in which the main portion of the work lies entirely outside
their interests or activities. That they can cooperate largely, however, in
educational work is clear, as more and more the special branches which they
represent become incorporated into the regular accepted plan or scheme of
training. Such subjects as obstetrics, and children's diseases are now com-
monly required, and it seems probable that for public health work, training
in contagious diseases, and possible in mental and nervous disorders may be
called for.
Special hospitals form numerically a very large group. They are often
large, well equipped and carefully administered, and they are not infrequently
well endowed and able to secure the best specialists in the branches they repre-
sent to direct their work. The nursing in such hospitals is carried on in sev-
eral ways — by the employment of a trained graduate staff of nurses, by post-
graduate courses, by affiliations with regular training schools, by maintaining
regular schools of nursing or, in the cases of hospitals for the insane, of schools
for the training both of nurses and attendants. The organization of this very
large and valuable field of training still remains to be adequately worked out
but in the main it seems fairly obvious that such hospitals can perform a better
service by making their ownspecal contribution to the training of nurses, than
by conducting regular schools of nursing. , Just because they are engaged in a
special branch of work, it is practically certain that their whole energy will
be thrown into efforts to make this branch still more highly and perfectly
specialized.
For this reason there is some genuine ground for question as to the ability
of such institutions to conduct schools of nursing professing to offer complete
general training. The main portion of the student's full period of training is
spent working among patients rightly grouped in a special class. This may
occupy two full years or even more, ou.t of the three, while in all accepted
schemes for a satisfactory arrangement of work, this same specialty would
seldom be given more than six months of time at the most. In addition to
this, the full emphasis must of necessity be laid upon that particular branch.
The impressions made upon the student's mind are in relation to a particular
type and condition — this is inescapable. The provision which is made for train-
ing in general nursing (or for all other branches) will be comparatively small,
and relatively all out of proportion in a sound scheme of training, and, further,
the order of things is reversed, and the special is made to precede the general
and fundamental.
The more important special hospitals are those dealing with obstetrics, men-
tal and nervous, contagious, and children's diseases. Children's depart-
ments are now increasingly found in general hospitals, and there appears to
be also an increase in the number of obstetrical wards. It is noticeable that
maternity hospitals in most instances affiliate and offer three or four months
of special training, to be included in the regular work of the student nurse. A
few offer post-graduate work also. Contagious hospitals occasionally affiliate,
but they appear more frequently to employ salaried graduate nurses varied
HOSPITAL AND TRAINING SCHOOL STANDARDS 15
with occasional post-graduate work. Hospitals for the insane and for children
more commonly establish regular schools and require that the bulk of the
student's training shall be received in the single special field represented.
The question of affiliations is a matter of extreme importance in making up
a proper curriculum for pupil nurses. It is important to ascertain just what
any possible affiliation has to offer, and how long should be given to it in a well-
balanced curriculum. The parent school should feel itself strictly responsible
for the standards both of practical and theoretical work in the affiliating
school, and should see to it that proper conditions of life and work and proper
guardianship are assured.
Efforts should be steadily made to bring about a better system of adjustment
and to see that training in special branches follows upon a general groundwork.
This could usually be easily done where the training school is under university
direction, and a unifying and coordinating power can thus be provided. In
every such special branch provision should be made for two types of students
— those who need some training in it as a part of a general course and those who
are choosing it as a field of special work. A longer period of training is neces-
sary for the specialist.
Hospitals and sanitaria under private ownership cannot be recommended as
suitable institutions to assume the direction of training schools for nurses.
Their purposes are frankly commercial, and under such government the exploi-
tation of pupil nurses is practically impossible to control. The maintenance
of satisfactory standards of teaching, of work, or of student-life, may be
assumed to be outside of their purposes and possibilities.
No attempt has been made in this study to consider the very important ques-
tion of post-graduate education for nurses. It may be said in passing, however,
that the same general principles which have been laid down for the training
of pupil nurses, apply to the courses for graduate nurses which are offered by
hospitals. The graduate student should have a curriculum especially ar-
ranged to meet her needs, and every facility should be given her so that she
may profit to the full by both her class work and her ward experience. Most
graduate students would be willing to pay for the kind of instruction they
need, on the condition that they should be released from the long hours of
exacting ward work, and should have the advantage of expert teaching and
supervision.
D. FINANCIAL RESOURCES
Schools of nursing at present everywhere rest upon an unsound and pre-
carious financial basis. None of them are endowed, none are maintained by
public funds — none, in fact, have any real resources whatever for the conduct
of their work beyond the provision which the hospital (whose nursing services
the school is supplying) is able and willing to make. Most hospitals find it
hard to get enough funds to keep their work going on a satisfactory basis.
They cannot contribute to the support of schools — on the contrary, they must
use the school to help support the hospital. A few hospitals may have some
means available, but as a rule their conception of the function of their train-
ing schools is so imperfect as to prevent serious consideration of their needs
from a financial standpoint. There is a slight awakening of interest in this
16 HOSPITAL AND TRAINING SCHOOL STANDARDS
aspect of affairs, but until it has taken a real hold on the minds of those re-
sponsible for the conduct of hospitals, and consequently of training schools for
nurses, until there is a wider understanding of the vital importance to society
of the work which nurses are doing, there can be little hope that schools of
nursing can be maintained upon a truly satisfactory economic basis, or
can render their full measure of usefulness to the public.
The hospital, under certain conditions, can provide largely of the main essen-
tials. Its wards form the indispensable laboratories for training in nursing;
its life and disciplines are of incomparable value in such training, but equally
necessary in any adequate system are bodies of trained teachers and suitable
places in which to teach; lecture, and class rooms, laboratories, libraries, and
other teaching equipment and material, scientific and technical. Equally
important are suitable conditions of student life and work. These costs of
education can never be neglected.
The ordinary needs for the proper conduct of the training school should be
considered carefully in the making up of the hospital budget. The head of the
school should be required to present an estimate of the probable expenses of her
department, which should include provision for necessary developments in any
desirable direction.
Where it is impossible for the hospital to supply the necessary funds, there
should be no hesitation in making direct appeals to private individuals or
associations, or, in certain cases, in asking for appropriations from public
funds for the proper financial support of the school. No school of nursing can
hope to carry on and develop its work satisfactorily without such support.
E. THE TEACHING FIELD (RANGE, VARIETY AND CHARACTER OF
SERVICES)
It is commonly accepted that a good teaching field must provide satisfactory
opportunities for training in the four main branches of nursing — medical,
surgical, obstetrical and children — and that the services must be reasonably
acute. Generally speaking, the value of any service from the standpoint of
training, is directly proportionate to the number of acute cases being cared
for. Chronic and convalescent cases are of limited value as teaching material,
though they call for certain special kinds of care, certain personal qualities,
and adaptations which should have a definite place in the scheme of instruc-
tion. The degree of acuteness may be measured by the number of admissions
per bed per year. A service in which the number of admissions per bed per
year averages from 16 to 20 or over, is an acute service. Below 8 per bed per
year, it would rank as an inactive service, and the diseases would probably be
sub-acute or chronic in character.
It must be recognized that the experience in medical wards particularly
varies greatly at different seasons of the year, offering excellent material for
study and nursing care during the pneumonia and typhoid seasons especially
but at certain other times giving little opportunity for observation and spe-
cial treatment. Efforts should be made by supervisors and instructors to see
that if possible, students whose experience in a given department has been
relatively uninstructive, should have an opportunity of supplementary train-
HOSPITAL AND TRAINING SCHOOL STANDARDS 17
ing later. In any case class teaching and ward clinics should help in making
up any possible weakness in practical experience. In each service the com-
moner varieties of cases should be found and when unusual forms of disease
are admitted, the opportunity for observation and instruction which they
present, should always be utilized as far as practicable for the benefit of all
student nurses.
From the standpoint of teaching, a large and active private service in a
hospital presents difficulties. It makes excessive demands upon the time of
administrative and supervisory staff, and occupies a relatively large place in
the general scheme of training. Furthermore it is a distinct loss to the stu-
dent, in that it substitutes the restricted experience of service with one or
two individuals, for the varied and instructive opportunities provided by the
many patients of the large open ward. It cannot be assumed that a student
who is assigned to the care of from one to three patients during a given period
can learn as much as during a similar period where from thirty to forty patients
may be under her observation and care.
The advantages to be derived from service in private wards are small in
comparison and quite special in nature. Undue emphasis has been placed
upon the value of this service, which, in the interests of good teaching, should
be kept at a reasonable minimum. There is a difference in equipment and in
some details of service for such patients, but there can be no difference in the
nursing, and it is of the utmost importance that this point shall never be lost
sight of. Standards and methods of nursing are the same, and special cases
require special nursing, quite irrespective of their place in the hospital or their
ability to pay. The large, open public ward is the ideal training ground for
student nurses. It has been suggested that the ratio of private to free patients
should not exceed one to four in teaching hospitals.
A complete medical service should provide training in the care of all the
usual medical diseases, and also in the nursing of communicable diseases.
So important, indeed, is this in the preparation of nurses for modern public
health work, that it is difficult to see how they can get along without it.
Affiliations should be sought which would provide this training in the acute
infectious diseases for those particularly needing it, even where it is not
required or obtainable for the entire student body. Facilities for training
in the care of nervous and mental patients should also be made available.
The surgical service should provide training in the care of all the ordinary
surgical diseases, and should include gynecology, orthopedics, operating-room
work, and training in that department in which accidents, emergencies, and
minor surgical matters are handled — whether this be in a special ward or
dispensary.
It is desirable that the obstetrical service be sufficiently large and active to
ensure a proper training within a reasonable period. Probably the measure
of training here should be determined by the number of cases, rather than by
the number of weeks.
The children's service should .provide opportunity for the observation and
handling of sick children not only in infancy, but up through the years of
childhood.. It is one of the most important of all the services, and with the
development of public health work, and the widespread introduction of nurses
18 HOSPITAL AND TRAINING SCHOOL STANDARDS
into public schools, it has become fundamental and indispensable in the scheme
of training.
The dispensary or outdoor service provides invaluable opportunities for
instruction. Patients visiting dispensaries for advice or diagnosis present
many conditions and states of disease rarely seen in the wards. The greater
the number of cases in each division under close and continued observation
and treatment, the more profitable the instruction to the student nurse. It
may precede or follow her training in the wards. Probably a period of service
in the early stage of training and again at a later stage, would prove of most
genuine educational value though it might be difficult to work out. Fre-
quenty a hospital will have a pretty well-developed dispensary or clinic for
which it has no corresponding hospital service. This would perhaps be par-
ticularly true of such special services as eye and ear, throat and nose, and skin
diseases which are of special importance to those intending to enter public
health work. The dispensary should play a much larger part in the training
of the nurse than it has hitherto usually done, and its special resources should
be as completely utilized as possible. As a partial preparation for almost any
form of public health work, it is of unquestionable value, and if it has a social
service bureau, with follow-up work in the homes, its powers in this direction
are greatly enlarged.
Where the hospital is used as a teaching ground for medical students or as a
field for medical research, the value of the service to the student nurses is
usually increased in certain ways. They work in an atmosphere of scientific
inquiry and must frequently assist in experimental work; and they share in a
measure in the instruction which goes on continually. In some departments
of work, however, there may be a distinct loss to student nurses, as for instance
when much of the required assistance in operating-rooms, dressing-rooms, etc.,
is taken over by the medical students.
F. CONDITIONS OF LIFE AND WORK FOR STUDENTS
Ratio of Nurses to Patients
The ratio of student nurses to patients cannot be worked out on any basis
which is capable of general application, because of the many and various
factors entering into the situation. It is affected by the number and variety
of services ; by the character of these services — that is, whether they are acute,
sub-acute or largely chronic in nature; by the proportion of private patients;
by the plan and arrangement of the hospital (small wards always requiring
a relatively larger service than large wards); and also in some degree by the
number of orderlies and other helpers of various kinds provided. A teaching
hospital where many clinics are held, and where medical students need to be
looked after and helped, requires a larger staff of student nurses. There is a
difference in the number of student nurses required in a medical and in a
surgical ward of the same size, and a wide difference, usually, between these
and the number called for in children's, maternity, infectious, or in mental
wards. The operating-room offers a special problem contingent upon the
number of operations daily. The dispensary and clinics must be governed by
similar conditions.
HOSPITAL AND TRAINING SCHOOL STANDARDS 19
The general opinion appears to place the ratio, at present, of student nurses
to patients in an active service about as follows :
Free ward service
Day duty 1 nurse to 5 patients
Night duty 1 nurse to 10 patients
Private ward service
Day duty 1 nurse to 3 patients
Night duty 1 nurse to 5 patients
This is the minimum ratio, it is believed, which can be accepted as likely,
under the usual conditions, to enable the school to maintain satisfactory
standards of work and teaching.
Hours of Duty
In the last analysis, the pivot upon which the whole curriculum swings, is
the system of hours of duty which the hospital requires of the nursing staff.
The very purpose of the instruction for which the student pays by her service,
is frustrated by long hours. Good teaching — any teaching, in fact — is wasted
on students who have been engaged in prolonged, heavy, physical effort, or in
exacting forms of nursing which involve considerable mental and nervous
strain. The senses are dulled, the mind works more slowly, concentration is
practically impossible, wrong impressions are frequently carried away, but
worse than all of these is the fact that the student acquires a distaste for the
work which is made too difficult for her to accomplish creditably. The fact
is that long hours of work for student nurses have been for a quarter of a cen-
tury the greatest stumbling block to progress in nursing. The whole experi-
ence of that period goes to show unmistakably that an adequate body of
instruction cannot be established by training schools, unless at the same time
a system of hours is arranged which permits the students to accomplish the
required study satisfactorily and without detriment to health and spirit.
But even if we do not consider the educational work which as a rule has been
carried on outside of the required number of hours of duty on the wards, the
nine- to ten-hour working day, the twelve-hour night and the seven-day week,
still required in most hospitals, would generally be considered excessive from
the standpoint of health and efficiency alone, even for laboring men. It is
strange that hospitals have been so slow in grasping and applying the findings
of science on the subject of fatigue. The eight-hour day has been so generally
accepted as the maximum for a normal, healthy life, especially under condi-
tions demanding physical effort and mental strain, and it has been enforced by
law in so many departments of the world's work, even under the unusual
demands of war, that the hospital lays itself open to peculiarly unfavorable
comparisons by its continued insistence on a policy which has been discredited
not only by scientific and educational authorities, but by frankly commercial
enterprises as well.
The long hours of night duty are particularly grave in their effects upon the
student's capacity to reap proper advantage from her instruction. Night
duty in itself, under any conditions, is disturbing to the maintenance of a good
system of instruction, in that each time the student is placed on night work
there is a temporary new adjustment of habits of daily life. But any person
20 HOSPITAL AND TRAINING SCHOOL STANDARDS
who has performed twelve hours of work such as is required almost universally
on night duty, should be looked upon as incapable of further effort — mental
or physical. Any kind of satisfactory educational work is made practically
impossible for such hours.
Training schools for nurses should be scrupulously sensitive in seeing that
the instruction they offer is given under conditions which will in no way lessen
or impair its value. It is necessary to be constantly watchful on this point,
because the needs of the hospital are imperative and difficult to satisfy, and
power and control are centered there. The head of the training school is fre-
quently all that stands between the students and the urgent demands of the
hospital for a larger service than can safely be required of them. Her vigi-
lance, courage, and sense of justice may be their sole protection against con-
ditions of life and work which would render of little value the best quality of
actual instruction which could be offered.
Although under the present system of education in nursing, tuition fees are
not required from students, a very exacting form of student service is required.
While, up to a certain point, we may look upon this service as indispensable in
our method of training, we should not forget that it is always of distinct and
substantial financial value to the hospital and that through it the student pays
the equivalent of the most ample tuition fees, and also pays for everything
else which the hospital provides her.
In so far as hours of work for pupil nurses are concerned, there is general
agreement that eight hours of practical work per day is the maximum which
can be required in a satisfactory scheme of training. The findings of the Com-
mittee, the opinion of heads of training schools, and the experience of those
familiar with the system coincide in approving the eight-hour schedule, and in
urging its adoption. They recommend that one afternoon of 6 hours per week
be allowed, making a total of 54 hours a week for practical work. Those who
have tried this system would not be willing to go back to the old, realizing that
not only is the actual nursing care of the patients of better quality, but that
good teaching becomes possible in the shorter day. Furthermore, it has been
shown that shorter hours and better teaching inevitably attract more and
better qualified candidates to the school.
The change from a nine- or ten-hour day to an eight-hour day will necessarily
call for an increase in the number of student nurses, and here one is met at
once by the lack of adequate housing accommodations, which is an almost
chronic condition in our rapidly growing hospital field. One solution of the
problem may perhaps lie in the adoption of the plan now being tried out in a
few hospitals of arranging for those students who have good homes in the com-
munity to live at home. A somewhat different adjustment of hours makes this
a practicable scheme, and it would provide a substantial increase in staff with-
out additional expenditure for quarters and maintenance. The principle has
for years been applied in arrangements for the service of special nurses in pri-
vate wards of hospitals and here it works out satisfactorily.
Housing and Living Conditions
It is hardly possible to overestimate the importance of the conditions under
which student nurses live. Next to hours of work these form the factors
HOSPITAL AND TRAINING SCHOOL STANDARDS 21
affecting most deeply their health, spirit, and general power to handle their
work efficiently or to derive benefit from the instruction and training which is
virtually offered in part payment for their services.
Among the essentials which should be provided in students' residences are
single rooms for all students. Double rooms should only be used when abso-
lutely unavoidable and should be looked upon as a temporary and undesirable
expedient. Student nurses receive their training under peculiarly difficult
and exacting conditions, and are subject to certain strains and to responsi-
bilities quite unlike those which students in any other profession whatever
have to meet. They need, when off duty, the quiet and privacy of individual
rooms — they need it for rest and most particularly for study. These rooms
should be comfortable, with good beds. They should be supplied with writ-
ing tables and shelves for books and papers. Pupils should always have good
lights to study by, since most of their study must be carried on in the evening.
There should be such provision made for personal clothing and other necessi-
ties a\s will enable the student to keep her belongings in good order. The
standards of living for the student must be such as she will be expected to
apply in the homes and institutions in which she works and teaches. These
standards include the maintenance of orderly and hygienic surroundings, and
immaculate personal cleanliness. The lavatories should provide ample facili-
ties for this and not less than one bath room for six students is looked upon
as meeting modern requirements.
The dietary should be especially adapted to students engaged in arduous
work involving physical as well as mental strain, and such disruption of normal
life as night duty or special duty usually brings. No body of persons in the
hospital needs more careful consideration on this point than the staff of student
nurses. There should be a carefully worked out menu, the food should be well
selected, well cooked and attractively served.
Suitable quarters should be provided for students on night duty, to ensure
protection from noise and other disturbances. The whole atmosphere of the
nurses' home or dormitory should be one of quiet comfort and refinement.
There should be suitable reception and sitting rooms and such service as is
necessary in maintaining a dignified, orderly, attractive and homelike
household.
A number of schools are now employing social directors, or house mothers,
to look after those aspects of the students' home life which the superintendent
and staff cannot possibly give much attention to, owing to their other en-
grossing duties. Definite provision is thus made for a wholesome and stimu-
lating social life in the home, and for the introduction of outside interests
which the pupil nurse particularly needs.
Fees and Allowances. Scholarships
It has long been the practice of hospitals to make a money allowance to
pupils of from four up to fifteen dollars per month, to cover expenses of uni-
form, text-books and other incidentals connected with their work. An in-
creasing number of representative hospitals are giving up this practice, and
are devoting the funds so released, to building up their educational system
22 HOSPITAL AND TRAINING SCHOOL STANDARDS
through better teaching and supervision, shorter hours of hospital work and
better living conditions.
Several schools have gone farther than this and are requiring a tuition fee
of from $25 to $50 or more for the preparatory period of training, and at least
one regular school of nursing requires tuition fees for the entire course of
training. A tuition fee for the preparatory term is a just charge in those
instances where practically the entire time of students is spent in class and
practice work which requires the employment of several special teachers
and supervisors. This fee is sometimes returned on the completion of the
training. It should not be charged where any considerable proportion of the
students' time in this preliminary period is spent in the hospital. It should
be understood that the fee will not be returned to those students who do not
remain after the preparatory term.
There is no doubt that the tendency at present is toward the payment of
tuition fees. Where this policy has been introduced and has been accompanied
by a radical improvement in the course of study and the introduction of other
features making for high standards of training, such as reasonable hours and
good living conditions, the result has always been to increase rather than
decrease the number of eligible applicants, and to definitely improve the class
of women entering the school. It is useless to introduce tuition fees unless
these conditions are assured.
There is little use made of scholarships in schools of nursing. A few leading
schools award them, but usually at the close of the full term of training, to a
student desiring further study in some special branch. There might well be
a wider use of scholarships, and they might be offered to exceptionally well-
qualified candidates who desire to secure training in nursing but are unable
to incur even the modest personal expenses which are usually a'l that student
nurses are required to meet. Provision for such candidates is made in vir-
tually all other educational institutions, and schools of nursing might through
the adoption of this policy find a way of admitting some unusually desirable
candidates.
G. THE ADMINISTRATIVE AND TEACHING STAFF (FACULTY OF
THE SCHOOL)
The requirements here may be briefly indicated by calling attention to the
double functions of practically all training school officers. They are respon-
sible for the whole scheme of instruction and training, which is essentially an
educational function; and they are also responsible for the efficient adminis-
tration and supervision of the nursing service of the hospital and frequently of
the housekeeping service as well, which are administrative functions.
The administrative and teaching staff of the school (sometimes called the
faculty) must generally include the following persons:
a. A superintendent or director of nurses, who is also the principal of the
school.
b. Assistant (one or more, in accordance with the size of the hospital and
school, and the character and dimensions of the work).
HOSPITAL AND TRAINING SCHOOL STANDARDS 23
c. Instructor (one or more, as needed).
d. Graduate nurses as heads of all departments (medical, surgical,
children's, maternity, dispensary, operating-room, etc.).
e. Night superintendent (with such graduate assistants as may be needed).
f. Dietitian (and assistants as needed).
g. In addition there should be a carefully selected and paid staff of lec-
turers in all the general medical and special subjects.
It is hardly necessary to say that the woman who is to direct the education
and training of nurses, and to direct also the nursing service of a hospital, even
of moderate size and under the least exacting conditions, must be herself an
educated woman. It is not enough that she should be a well-trained nurse
with varied experience and also a reliable and trustworthy woman. These
two considerations are indispensable. Nor is she to be considered qualified
because she is a good business manager. Details of office management and
ward supervision can be delegated to assistants, but the superintendent of
nurses must herself be able to plan and direct the work of the school and must
be able to coordinate it with the work of the hospital. She must under-
stand people and be able to secure their cooperation, and she must have that
kind of personality and judgment which will command the confidence and
respect of her associates. It is imperative that the director of a school of
nursing which undertakes to prepare young women for one of the most impor-
tant of modern professions, should have a sound educational background and
a broad point of view, so that she will be able not only to maintain satis-
factorily already established standards, but to work out new methods and
new educational policies in accordance with the needs of the times.
As far as is practicable, a similar kind of education, of training, and of per-
sonal qualities should be required of assistants and graduate heads of depart-
ments. In addition to purely executive duties, they will all have to supervise
and criticize the work of students and in many instances to assist actively in
the regular teaching. It is desirable that as far as practicable, the heads of
special departments should be prepared to teach the branches they represent.
In most schools it will be necessary to employ at least one regular instructor
who will be more directly responsible for the teaching of the younger nurses.
She will usually be expected to teach the elementary sciences as well as the
fundamental principles and technic of nursing.
To hold the interest of pupils and to stimulate them to their best efforts,
both in their theoretical and practical work, the instructor needs to have a
strong and vigorous personality and a fund of real enthusiasm for her work.
She should be approachable and helpful in dealing with pupils, but at the same
time should show a reasonable degree of firmness and decision in keeping them
up to a good standard of work. No one should attempt to teach who has not a
fairly keen, well-balanced and well-ordered mind, a real love for study and a
strong desire to help young nurses to enjoy their work and get the most out of
their training.
The instructor should know thoroughly the subjects she is to teach. It is
not possible to make this knowledge exhaustive, but it should be authoritative
and up-to-date, and always well in advance of her class. She must be con-
24 HOSPITAL AND TRAINING SCHOOL STANDARDS
«
stantly refreshing and supplementing her knowledge by study and observation,
or her work will inevitably suffer. The teacher must also have a wide practical
experience in the branches she teaches, and should be expert in demonstrating
practical procedures.
In addition to sound technical and professional training, some experience
and training in teaching is almost essential. Fortunately many nurses have
had Normal School preparation and have taught in elementary or high schools,
but most of those who plan to teach in training schools will need to take special
courses, both to increase their knowledge of their subjects and to help them to
teach more effectively.
As far as possible, all those who are concerned with the teaching work of the
school should have these personal and professional qualifications. For all the
special branches, such as dietetics, massage, pathology, etc., specialists will be
needed, and though it is perhaps of first importance that they should be experts
in those branches, this in itself would be of small value without the ability to
"get the subject over" to the pupils. Physicians should be employed for all
subjects dealing with the actual study and treatment of disease, such as sur-
gery, obstetrics, etc., and they should be specialists in those branches, so far
as possible. In each of these subjects, however, there are demonstrations and
discussions of nursing treatment and technic which are better handled by
nurses. As far as possible, the supervisors who have charge of the practical
training in these special departments should be responsible for the nursing
classes and quizzes which supplement the doctor's lectures on the various
special branches.
All good teaching requires time for preparation, and this should always be
allowed for, as well as the correcting of note-books and the other routine work
entailed in all branches of teaching. The instructor whose whole time is
given to teaching should not be expected to give more than from four to five
hours daily in actual class-room work, and she should be completely set free
from all routine executive duties of the hospital which have little or no relation
to teaching work.
While it is important that the number of persons on the administrative staff
should be sufficient for the demands of the work, its real strength must be
determined not by numbers, but by the preparation and the personal qualities
which each member contributes. It is practically impossible to conduct a
good school without a well-qualified body of officers and teachers, all working
together in the interests of students, and of the people whom these students
are ultimately destined to serve.
H. STANDARDS OF ENTRANCE TO SCHOOLS OF NURSING
Education
Schools of nursing in good standing should require all applicants to present
evidence of graduation from a four-year high school, private school or other
secondary institution of approved standards, or to provide satisfactory
credentials from responsible school authorities showing that they have re-
ceived the equivalent of high school training. In every case the fundamental
HOSPITAL AND TRAINING SCHOOL STANDARDS 25
subjects, such as high school English, history, mathematics, and science must
have been thoroughly covered. In most good high schools the study of Latin
or one modern language is also required for graduation. Training school
officers should be provided with the lists of accredited high schools, and in any
case of doubt should investigate the standing of the school.
Where it is impossible at once to require full high school standing, two years
is suggested as a temporary minimum, with approved and certified courses in
English, mathematics, history, and elementary science. Any school wishing
to attract the better class of applicants, will give preference to those with
higher educational credentials, and will proceed as rapidly as possible to the
full high school requirement, which is insisted upon for every other type of
professional training.
Nursing schools should secure the cooperation of high school principals and
teachers, in urging girls who are interested in nursing to complete the full high
school course, and in advising them regarding the best selection of pre-nursing
subjects. Such students should all complete the regular college preparatory
work if possible, because they may wish to enter a college for part of their pro-
fessional work either before or after training, and because the regular cultural
courses are all desirable as a basis for nursing work. Wherever there is free-
dom for election, science courses, especially chemistry, physics and physiology,
should be chosen, and household science should be included if at all possible.
Mathematics is of relatively minor importance (apart from good sound arith-
metic). It is a disputed question whether a modern language is not of more
value than Latin, but one year at least of Latin is decidedly helpful in getting
hold of technical terms. Music, drawing, physical training and voice culture
are all helpful and should be included if possible.
Deficiencies
Applicants who are deficient in general education, but who qualify in other
ways, should be advised to make good the deficiency by returning to high
school, attending night school, taking extension or summer courses in con-
nection with a university or normal school, or by securing a special tutor to
prepare them for the state examinations. Slight deficiencies might be made
up after entering the nursing school, but this is not generally advisable, owing
to the pressure of other studies and the demands of practical work. It should
be distinctly understood that credits for admission to nursing schools should
be made up in approved high school subjects and not in stenography, book-
keeping, and other technical courses which would be of much less value as a
basis for nursing work. As a rule, such subjects as English, history or civics,
chemistry, physics, biology and arithmetic (if not covered elsewhere) should
receive first place, but languages, physical geography, and household science
would also be of definite value to the prospective nursing student.
Advanced Standing
It is recommended that applicants who bring educational credentials in
advance of high school graduation, should be allowed advanced standing in
nursing schools under the following conditions :
26 HOSPITAL AND TRAINING SCHOOL STANDARDS
1. Graduates of approved colleges giving the regular four-years' course lead-
ing to the A.B. or B.S. degree, should be allowed credit in time amounting to
one academic year (eight or nine months), and should not be required to repeat
class work which had been satisfactorily covered elsewhere.*
It is suggested that this reduction in time should be allowed only to those
who have graduated comparatively recently, and who have completed satis-
factorily in college about one year's study in each of the fundamental sciences
on which nursing is based — biology, chemistry, sociology and psychology. The
year of biology might include such subjects as physiology, bacteriology, bot-
any, nutrition, hygiene, and sanitation; physics might be accepted for part of
the year of chemistry; economics or social economy-for the sociology require-
ment, and courses in ethics or education for part of the year in psychology.
One year's work in a given subject usually means from two to six hours weekly
throughout the year in that subject, depending on whether it is a lecture or
laboratory course.
2. Students from schools of household arts, normal schools, and others
representing work in advance of high school, who have completed satisfactorily
such subjects in the training school curriculum as anatomy and physiology,
bacteriology, chemistry, nutrition and cookery, etc., should be exempt from
compulsory attendance on those courses, but should be required to take
examinations with other students.
3. Credit for previous work in approved training schools should be granted,
providing the student's character and records are satisfactory, the reasons for
changing are good, and the experience in the first school is comparatively
recent. A minimum of about two years should be spent in the hospital giving
the diploma. Such a student should not be required to repeat work already
satisfactorily covered in theory or practice.
Age
The minimum age at which students should be accepted in schools of nursing
is twenty years, with occasional exceptions in favor of young women of nine-
teen years of tested capability and unusual maturity, both physical and
mental. The maximum age should be about thirty-five years, with rare ex-
ceptions in favor of persons of unusual physical vigor and proven adaptability.
Health
The applicant should be of average height and weight and free from organic
defects. She should present a recent certificate of good health from a physi-
cian, showing not only that her constitution is sound and her general resistance
good, but that her mental and nervous make-up is normal and stable, and her
whole personality of a good wholesome type. This is a protection both to the
school and the student. A certificate from a dentist should also be required.
* A number of representative training schools have recently (1917) agreed
to admit college graduates on this basis, and already there is a very gratifying
increase in the numbers of college women coming into the profession. Sug-
gestions for working out a scheme of training under these conditions will be
found in Appendix V.
HOSPITAL AND TRAINING SCHOOL STANDARDS 27
Before acceptance into the school, the student should have a thorough physical
examination by the training school physician, and it is very desirable that a
similar examination should be made at the 'end of the training, to determine
just what the general physical effects of the training have been.
Character and Experience
Certificates of character are usually of uncertain value, but should be re-
quired in view of the nature and responsibilities of the nurse's work. A per-
sonal interview with the applicant is always desirable. Direct correspondence
between the school and the persons given as reference is advised. Wherever
there seems to be any doubt as to character, a careful investigation should be
made. Experience in home management, in business and in social, educational
or club work, are distinct assets. The applicant who belongs to a cultured
family with traditions of public service, who has travelled and seen something
of life and people, is (other things being equal) generally found to be better
fitted for success in nursing work.
I. THE ADMISSION OF CLASSES
Among the many points in the organization of training school work which
need careful consideration, is the question of the number of classes admitted
yearly. In some schools new classes are formed twice yearly; in others three
or even four times yearly; in still others students are admitted irregularly,
whenever vacancies must be filled. It is hardly necessary to point out that
this method makes the conduct of a good curriculum exceedingly difficult.
Certain subjects must be repeated three or four times during the year, and
students must of necessity enter some of the classes in which repetition is
impossible at late dates, and endeavor to pick up what they can. The burden
laid upon the teaching staff of constant repetition is a heavy one, which the
always insufficient force of instructors complicates. So long as the system of
student nursing service exists, it will undoubtedly be necessary to admit
students twice yearly, in order that the hospital service may not suffer from
the removal at any one time of a considerable number of skilled workers, but
in the interests of both students and teachers, the time of admitting classes
should be kept as nearly as possible to twice yearly. The commonly accepted
time in most training schools now conforms to those in other kinds of schools
— in September or October for the autumn and in January or February for the
spring. In establishing relationships with colleges or other similar institu-
tions, these periods will be found convenient as fitting in closely with their
schemes of teaching.
J. STANDARDS AND METHODS OF GOOD TEACHING
In teaching nurses we have always to keep clearly in view the objects of the
training. If the pupil is to be able to undertake the duties and responsibilities
which meet her in the hospital and in the various fields of nursing outside, she
must have not only a certain amount of sound knowledge, a high degree of
28 HOSPITAL AND TRAINING SCHOOL STANDARDS
technical skill and the spirit of service, but she must have a well-trained mind,
good powers of observation, the ability to handle people and to manage affairs,
and high ethical standards.
The test of the teaching done in any school will be found not only in the
examination records, but in the actual accomplishment of these results by the
pupil. It should be judged not only by the present standing, but by the
future growth and progress of the members of that school. The quality of
teaching can be measured by a few fundamental tests :
First. Where good teaching is being done the pupils are interested in their
work — they do not need to be driven to it by threats or bribes. The work is
vital to them because it meets their needs, it helps them to solve their problems
and it arouses in them worthy and serious hopes and ambitions which persist
in their future life.
Second. The pupils are doing real live thinking for themselves, and not
simply memorizing facts. They are observing, comparing, judging, and learn-
ing to seek out reasons and weigh conclusions. They show good sense and
rational judgment in their handling of every-day situations, as well as in their
class work. They relate their theory to their practice.
Third. The pupils show the clearness and thoroughness of their knowledge
by their ability to systematize and classify their ideas and to find them when
needed. They do not simply accumulate masses of scrappy, unrelated facts.
Their answers to questions, their class notes, and their method of setting about
a practical task, will all show their ability to grasp the essential points, to sub-
ordinate the unessential and to focus all their resources on the problem in
hand.
Fourth. Good teaching is shown by the degree of self-reliance, initiative and
resourcefulness developed in the pupils, and their ability to adapt and apply
their knowledge in new situations. The pupil who is absolutely dependent on
the teacher, who cannot take any step without guidance and help, will not be
of much use in the hospital or in the future work of her profession. The kind
of teaching which substitutes tradition and authority for inquiry and investi-
gation, which discourages mental activity and free self-expression and which
destroys originality and initiative, is no longer accepted as good in any branch
of education.
The first thing for a teacher to decide is just what she wants to accomplish
through any given subject, and she must then plan all her work with this in
mind. She must also study her pupils to see what kind of material she has to
work with, and what foundations she has to build on, so that the work may be
neither above nor below their capacity. She must select her subject-matter
with these two things in mind, and must then arrange an outline of work in
each subject, divided into well-defined topics, which will receive attention in
proportion to their relative importance. Different subjects in the curriculum
should be correlated in every possible way.
Every detail of teaching should be planned out ahead, and not left to the
spur of the moment. Slavish dependence on a text-book usually means slip-
shod, ineffective teaching, and rambling remarks, no matter how interesting,
can never take the place of clear-cut, well-directed questioning and thoughtful
discussion.
HOSPITAL AND TRAINING SCHOOL STANDARDS 29
A lesson-plan should be made out for each class, taking up in the form of a
well-organized outline, all the main points to be discussed. The teacher
should also have thought out beforehand her procedure in the teaching of the
lesson — the important questions she is to ask, the blackboard illustrations she
is to use, the devices and material for demonstration and the plan for the pupils'
practical work, reference readings, study, etc.
The work of the class-room should be organized so as to secure the maximum
of cooperation and efficiency, and the least loss of time and energy. This is
especially important in the arrangement of classes in practical work, where,
owing to lack of equipment and limited space, there is often serious waste of
time for both pupils and teacher. It is scarcely necessary to state that classes
should begin on time and finish on time, and that regular and prompt attend-
ance on classes should be insisted upon.
The type of class exercise or recitation should be adapted to the subject
taught, to the time available, and to the resources of the school. Those which
are best adapted to the work in training schools and which are suggested in
this curriculum, are as follows:
The Lecture Method
This takes the form of a talk or address by the teacher, with no questions or
responses by the pupil. It can be used profitably for introducing new material
or arousing interest in a subject. It is economical of time, but it is limited in
its teaching value unless supplemented by other methods.
The Recitation Method
This covers a variety of class exercises — the drill, the quiz, the oral or writ-
ten review, as well as the testing of assigned recitations. The problem method
is a newer form of class exercise which is devoted to the discussion and solving
of certain typical problems or situations which the pupil is likely to meet in
actual life. Such methods help to maintain higher interest, help to clear up
difficulties and test the actual knowledge of the pupil, as well as develop the
power of oral and written expression and judgment.
One or more of these methods would be used alone or in combination with
other methods in practically every lesson. Their success depends on the skill
of the teacher in putting live questions and directing discussion along profit-
able lines.
The Demonstration or Clinic
This is a lesson conducted at the bed-side or in the demonstration room, for
the purpose of showing certain conditions or performing certain experiments
or practical procedures for the class. It is especially useful in the presentation
of medical subjects and, in combination with the two previous methods, is
used in nearly all the scientific and practical subjects. The excursion method
is a modification of the demonstration, where pupils visit places illustrating
certain conditions which they wish to study.
The Laboratory Method
Pupils here actually carry out experiments and practical procedures, in
order to get a more complete understanding of the principles involved and to
30 HOSPITAL AND TRAINING SCHOOL STANDARDS
gain skill. This method is used in combination with those previously men-
tioned in all the scientific subjects (anatomy and physiology, chemistry, bac-
teriology, etc.) and in all the practical subjects (nursing, cookery, massage,
etc.). It takes time, but is an extremely valuable and effective method of
teaching, if properly handled. No up-to-date school or college attempts to
teach any science or art, without providing laboratory facilities for each
pupil.
The Conference or Case-Study Method
This is used with more advanced pupils, who are capable of gathering to-
gether their own material and presenting reports on their observations or
practical work, which are then discussed and criticized by the class and
teacher. Such a method can be most profitably used in such subjects as
Professional Problems, Introduction to Public Health Nursing, etc.
The Study Period
With more immature pupils it is often found helpful to arrange definite
periods of supervised study, with instruction in the method of study and dem-
onstrations in the use of reference materials, taking of notes, etc. This is
particularly necessary in the preparatory period, where pupils have difficulty
in acquiring the habit of study and where it is important to economize every
available minute of study time.
The teacher who has had no special training in teaching will find it very help-
ful to study some of the books on teaching which are included in the bibliog-
raphy at the end of this article. It is suggested that groups of head nurses
and supervisors might be organized for the study of some of these commoner
teaching problems, and if regular lecturers cannot be secured from a university
or normal school, they might form into a club for the discussion of teaching
and administrative problems.
K. TEACHING EQUIPMENT
To accomplish satisfactory results, a school should provide for its teaching
work comfortable, well-lighted, well-ventilated class-rooms and laboratories,
such as are found in all modern educational institutions. The number and
size of the class-rooms will depend on the size of the school, but most schools
will need at least a general class and lecture room, a demonstration room, and
a diet kitchen equipped for teaching. A science laboratory for the teaching
of chemistry, anatomy and physiology, bacteriology, solutions, etc., is also
desirable, but in a small school the regular class-room, or demonstration room,
or the pathological laboratory may be equipped to serve for this purpose.
Where the hospital does not afford a well-equipped dietetic laboratory, it is
often possible to secure the use of a high school or technical school laboratory.
Medical schools may also furnish excellent facilities especially for the teaching
of the sciences. All class-rooms should be supplied with ample blackbard
spaces and cither chairs and tables, or chairs with the desk arm.
Under each course will be found a suggestive list of equipment and illus-
trative material to be used in teaching the various subjects. While ample
equipment is not enough in itself to guarantee good teaching, it is practically
HOSPITAL AND TRAINING SCHOOL STANDARDS 31
impossible to teach nursing subjects without a fairly complete and up-to-date
equipment and abundance of illustrative material. Much of this is easily
secured in a hospital (beds, linen, utensils, chemicals, laboratory supplies,
etc.), and a great deal can be readily improvised by an ingenious teacher.
The bulk of the material for class-room use should be kept for this purpose
only and should be properly arranged and cared for, so that it will not be
scattered and destroyed.
A good reference library is absolutely essential to satisfactory teaching
work. The size of the library is not the main thing, though it is important
that it should represent a fairly wide range of subjects. The books must be
up-to-date and reliable, and in good condition. If possible, a special room
should be set apart for the reference library where students can read and study
without interruption, and a responsible person should be put in charge. It is
very important that students should have easy access to the reference books
and that they should be encouraged to make the fullest possible use of them.
The text and reference books and magazines recommended under the different
subjects of the curriculum would make a fairly complete working library for
the average training school. If it is impossible to secure all of these books,
the public library is usually willing to put upon its shelves books of a more
general nature which will be used by pupil nurses, and in many cases will
install a "travelling" unit, or a branch library in the school.
L. RECORDS
It is essential that a good system of records should be established which will
provide full and exact statements. of the work which every student has done,
and which will also give certain details regarding the health, general education,
personality and character of each student who has been in the school. The
importance of this matter can hardly be overestimated. Records are needed
constantly for reference by the superintendent and staff of the training school,
and serve as a useful check of the actual training which each pupil is getting.
A new superintendent entering a training school has no other means of deter-
mining the standing of the pupils and the experience they have had. The
graduate nurse who wishes to enter the Red Cross, or take any of the post-
graduate courses which are now offered in colleges, will have to furnish com-
plete records of her work in the training school. The only way in which these
records can be supplied is through her school, and if they are not available, the
standing of both the nurse and the hospital is likely to be seriously questioned.
The records of theoretical instruction should cover the subjects, the number
of periods of class, lecture or laboratory in each, the years in which each sub-
ject was studied and the grades which the student has made. Class books,
with a record of attendance for each class, should be kept by each teacher, and
the results filed on the student's card when the class has been completed.
The record of practical training in each department should include the dates
of such periods and the number of days or weeks in each. As before stated,
the time spent in a given department may not accurately indicate the actual
training and experience of the student, but at present this seems about the
only method of measurement available, except in maternity work, where the
number of cases often determines the period of training. It is suggested that
32 HOSPITAL AND TRAINING SCHOOL STANDARDS
every effort be made to keep track of the number and variety of cases which
the student has observed and cared for, in all services, and that a blank be
supplied to each student for this purpose. A number of suggestive blanks
will be found in the Modern Hospital of July, 1917, covering not only the
records of pupils in the school, but also admission blanks, health certificates,
etc.
It cannot be too strongly emphasized that a few simple blanks, kept with
absolute accuracy, are of greater value than a very elaborate system which is
poorly kept. It is obvious that properly trained secretarial help is required
for the handling of such records, and correspondence relating to the school,
and that the valuable services of expert nurses should not be employed in this
way under ordinary circumstances.
M. UNIVERSITY AFFILIATIONS
The advantages of university or college relationship for schools of nursing
are likely to be very great. Precisely those essentials in all educational work
which the hospital finds it most difficult to supply, are freely available in every
college or university of good standing — properly equipped class-rooms and
laboratories, libraries and other teaching material; adequately trained teach-
ers ; associations with teachers and students interested in other lines of thought
and activity; the atmosphere of study — all of these, and other things less
tangible are to be expected from any good university connection. The results
in improving the standards of theoretical work in schools of nursing in helping
to maintain the right balance between theory and practice and particularly
in attracting better qualified candidates, can hardly be overestimated.
The value of this relationship appears to be in proportion to the degree in
which the university participates in the direction of the entire scheme of train-
ing school work. Several such schools now established as regular departments
of universities, give evidence not only of excellent standards and ideals of
work, but of ability to grow and develop, to try out new ideas and methods.
Where, however, the university opens up its class-rooms and laboratories
to classes of students from schools of nursing and fails to look into the nature
of the practical training in the hospital and the conditions under which it is
carried on, the result may be far from satisfactory.
The university must exact thorough work from its students, and it must
require a good many hours of study. If this is combined with the usual hours
of duty, there is imposed upon the student a program of study and work which
it is entirely impossible for her to carry out. All university relationships pre-
suppose a rational system of hours of duty, and there can be no escape from the
ruling that every increase in the amount of theory means a corresponding
decrease in the amount of practical work.
N. REFERENCES ON NURSING EDUCATION AND TEACHING
ROBB, ISABEL HAMPTON. Educational Standards for Nurses.
BEARD, RICHARD OLDING. The University Education of the Nurse. Fif-
teenth Annual Report of Society of Superintendents of Training
Schools (1909), also Teachers College Record, May, 1910.
HOSPITAL AND TRAINING SCHOOL STANDARDS 33
The Trained Nurse of the Future. Journal of the American Medical
Association, December 13, 1913.
WASHBURN, F. A. (M.D.) Supply of Pupil Nurses and Nursing Standards.
Fourteenth Annual Report, American Hospital Association, 1912.
ROWLAND, J. B. Obligations of the Hospital and the Public to Training
Schools for Nurses. Journal of the American Medical Association,
. December 13, 1913.
SMITH, WINFORD N. (M.D.) The Educational Function of the Hospital.
Twenty-first Annual Report of the National League of Nursing
Education (1915).
HALL, HENRY C. The Trusteeship of Training Schools. American Journal
of Nursing, May, 1915.
HURD, HENRY M. (M.D.) Shall Training Schools be Endowed? American
Journal of Nursing, September, 1906.
FAVILL, HENRY B. (M.D.) What the Medical Profession Can Contribute to
Nursing Education. American Journal of Nursing, January, 1916,
and Twenty-first Annual Report of National League of Nursing
Education (1915).
MURPHY, FRED T. (M.D.) Demand and Supply as Related to Nurses and
Nursing. Modern Hospital, October, 1914, and Twentieth Annual
Report of National League of Nursing Education (1914).
DOCK, GEORGE (M.D.) Essentials of Professional Education. Twentieth
Annual Report of National League of Nursing Education (1914).
WINSLOW, C.-E. A. The Public Health Nurse and Her Preparation for Her
Calling. Pamphlet, published by National Organization for Public
Health Nursing.
NUTTING, ADELAIDE. Educational Status of Nursing (Pamphlet, Publication
Bureau, Washington).
A Sounder Economic Basis for Training Schools for Nurses. Teachers
College Record, January, 1916.
Hospital Trustees and the Training School. Twentieth Report of
National League of Nursing Education (1914).
Some Problems of the Training School for Nurses. Transaction Ameri-
can Hospital Association, 1908, and Canadian Nurse, December, 1908.
Some Ideals in Training School Work. Twenty-second Annual Report
of National League of Nursing Education (1916).
GOODRICH, ANNIE W. How Shall the Superintendents of Small Hospitals Be
Trained? The Modern Hospital, November, 1916.
STEWART, ISABEL M. Problems of Nursing Education. Teachers College
Record, May, 1910.
Apprenticeship as a Method of Vocational Education (with Special
Application to Nursing). Seventeenth Annual Report of Society of
Superintendents of Training Schools (1911).
BELL, ALICE. Training School Records. Modern Hospital, July, 1917.
TUCKER, KATHARINE. The Training School's Responsibility in Public Health
Nursing Education. Twenty-second Annual Report of National
League of Nursing Education (1916).
34 HOSPITAL AND TRAINING SCHOOL STANDARDS
FOLEY, EDNA L. Fundamental Requirements in the Training of the Public
Health Nurse. Twentieth Annual Report of National League of
Nursing Education (1914).
LEE, FREDERICK, S. (M.D.) Fatigue.
GOLDMARK, JOSEPHINE. Fatigue and Efficiency.
BULLETIN 221. United States Bureau of Labor-Statistics. Hours, Fatigue
and Health in British Munitions Factories.
JAMME, ANNA. Effect of Legislation upon Schools of Nursing in California.
Modern Hospital, August, 1915.
SNEDDEN, DAVID. Problems of Vocational Education.
DEWET, JOHN. How We Think.
McMtiRRY, FRANK M. How to Study.
STRAYER, GEORGE D. AND NORSWORTHY, NAOMI. How to Teach.
PARKER, SAMUEL C. Methods of Teaching in High Schools.
BETTS, GEORGE H. The Recitation.
WHIPPLE, GUY M. How to Study Effectually.
JAMES, WILLIAM. Talks to Teachers.
Psychology (Briefer Course).
THORNDIKE, EDWARD. Elements of Psychology and Principles of Teaching.
Individuality.
COLVIN, STEPHEN S. AND BAGLEY, WILLIAM C. Human Behavior.
PALMER, GEORGE H. AND FREEMAN, ALICE. The Teacher. Houghton-
Mifflin.
See also articles in American Journal of Nursing and other Nursing Periodicals.
THE COURSE OF STUDY
A. LENGTH OF COURSE AND GENERAL DIVISION OF TIME
The length of the course is three calendar years, divided into the preparatory
or first year, the junior or second year, and the senior or third year.
One month should be allowed each year for vacations. These should all be
arranged for the summer term, when no lectures and classes are being given.
The academic or class year would be the same as in most other educational
institutions, extending from the first week of October till the end of May,
(about thirty- two weeks).
This period is generally divided into two terms of about sixteen weeks each
— the first, or winter term, extending from October to January (allowing at
least one week for Christmas vacation) ; the second, or spring term, extending
from February till May. New classes would be admitted in the beginning of
the winter and spring terms only.
It would usually be assumed that the last week of each term would be de-
voted to examinations, leaving about fifteen weeks each term for class and
lecture work.
The general schedule of hours suggested for the first four months or prelimi-
nary term is as follows :
4 hours daily in practical work.
3 hours daily in lecture and class.
3 hours daily in study and practice.
2 hours daily in recreation.
For the subsequent terms the schedule would be as follows :
8 hours daily in practical work,
f to 1 hour (average) daily in lecture and class work.
1 hour daily for study.
2 hours daily for recreation.
This means 10 hours of actual required work daily throughout the academic
year — with the exception of Sundays, when class work and study would be
omitted, and the one day a week when an afternoon off is allowed. So far as
possible evening hours should be left free from all class and lecture work.
The hours for night duty should be the same as for day duty — in any case
never to exceed ten hours a night. The total length of night duty should not
exceed four months and not more than two months' night duty should be given
at any one time. The first term of night duty should be as an assistant, not in
charge of a floor.
B. GENERAL SCHEME OF PRACTICAL INSTRUCTION
Division of Time for Practical Work
Preliminary or Probationary Period 4 months.
If possible, the pupil is not to be counted upon for any regular ward
duties during this time, and her practical work should not exceed 4
hours daily. Her practice in the various departments is for the pur-
35
36 THE COURSE OF STUDY
pose of giving her a background for her class work, and helping
her to apply the methods which she has learned in the class-room.
It is also an opportunity for testing out her ability for nursing work.
The practice should be closely tied up with her studies, and should
be under the careful supervision of the instructor. Each pupil
should, if possible, have a short period of time in each of the fol-
lowing departments: — diet kitchen, hospital supply-room, linen-
room, dispensary, and wards. Time should also be provided for a
few visits to homes with social service workers or visiting nurses, in
order that the pupil may see for herself the conditions under which
many of her patients live.
Medical Nursing 8 months.
This time is to be divided among medical wards (men's and
women's). The medical service should provide experience in the
care of all the commoner medical diseases, the greater proportion of
which should be acute. In addition to typhoid fever, pneumonia
and such communicable diseases as may be cared for in general medi-
cal wards, it is important that experience should be given in the care
of tuberculosis and also, if at all possible, the acute infectious dis-
eases, such as scarlet fever, diphtheria, measles, etc. If the hospital
docs not care for mental and nervous cases, it is urged that affilia-
tions with mental hospitals should be secured to give this training.
Surgical Nursing 8 months.
This should be divided among surgical wards (men's and women's)
and should include gynecological, orthopedic and operating-room
services. The surgical experience should represent a fairly wide
range of operative cases, including emergency work. Opportunity
for assisting at operations and doing surgical dressings should also
be provided.
Nursing in Diseases of Infants and Children 4 months.
This time should be given in special wards or in an affiliated hospital
devoted to the care of infants and children. It should include both
boys and girls and should cover both medical and surgical conditions
of childhood. If possible, some experience should also be given in
the handling of fairly normal run-about children, such as may be
be found in the children's clinic. Visiting or follow-up work in
connection with the children's services is also important. Work
in the milk-room, in preparation of infant's feedings should be
included in this period.
Obstetrical Nursing 3 months.
This should be given in special maternity wards or in an affiliated
hospital devoted to obstetrical work. It should include the care of
both normal and operative cases, and of normal and premature
babies. Out-patients' service, if provided, should be supplemen-
tary to the above, and given only under expert supervision.
Nursing in Special Diseases 2 months.
It is desirable, though not always possible, to give practical experi-
ence in eye, ear, nose and throat work, occupational, venereal and
THE COURSE OF STUDY 37
skin diseases, etc. This may be secured either in the dispensary
or wards — preferably in both. It is particularly important for
those who are planning for public health work.
Electives 4 months.
This period should be arranged, so far as possible, with reference
to the special aptitudes and future plans of the pupil. Those in-
tending to do private nursing might spend part of the time in the
private wards or in special duty. Those intending to enter some
form of public health nursing should be detailed to the hospital
social service department, or to an affiliated visiting nurse associa-
tion (only, however, when the practical work there can be as thor-
oughly supervised as the work in the hospital). Those who expect
to go into some form of institutional work may assist a head-nurse
or supervisor in charge of some hospital department. For the
remainder of this period, the pupil may be assigned to one of the
regular services in which she wishes to secure further experience
and training, or to some special branch of work, such as contagious,
mental hospital, or laboratory work, which may not be included in
the regular training.
Vacations (one month each year) 3 months.
Total 36 months.
Arrangement of Practical Training
No fixed order of services can be recommended, as this must depend on a
great many factors which vary widely in different hospitals. In general, how-
ever, it is believed to be important that experience in medical and surgical
nursing, should precede training in special branches and that services demand-
ing the more fundamental and uncomplicated measures, should precede those
which demand considerable differentiation and a higher degree of skill and
adaptability, such as mental nursing or children's nursing. Operating-room
work should precede obstetrics and all the regular branches of hospital service
(such as children, obstetrics, contagious, etc.) should be covered before the
pupil takes up public health nursing or social service. The following arrange-
ment is suggested :
Preparatory or First Year:
Elementary nursing, diet kitchen (elementary) and hospital
housekeeping (in preliminary course). General medical and general
surgical services.
Junior or Second Year:
Infectious, tuberculosis and admitting services (if given); chil-
dren's service and milk-room; gynecological, orthopedic, operating-
room and obstetrical services (the latter will frequently be extended
into the third year).
Senior or Third Year:
Psychopathic service (including practical work in hydrotherapy
and occupation therapy, where possible), dispensary, special dis-
eases. Advanced or special work in any one of the regular depart-
38 THE COURSE OF STUDY
ments. One of the following electives — (1) special duty or private
ward service, (2) hospital social service or visiting nursing service,
(3) executive work as assistant to head-nurse or supervisor.
C. GENERAL SCHEME OF THEORETICAL INSTRUCTION
* Preparatory or First Year
First or Winter Term hours
Anatomy and Physiology 60
Bacteriology 20
Personal Hygiene 10
Applied Chemistry 20
Nutrition and Cookery. r 40
Hospital Housekeeping 10
Drugs and Solutions 20
Elementary Nursing Principles and Methods 60
Bandaging 10
History of Nursing (including Social and Ethical Principles). . . 15
Total , 265
Second or Spring Term
Elements of Pathology 10
Nursing in Medical Diseases 20
Nursing in Surgical Diseases 20
Materia Medica and Therapeutics 20
Diet in Disease 10
Elements of Psychology (recommended) 10
Total 80 to 90
Junior or Second Year
First or Winter Term
Nursing in Communicable Diseases 20
Nursing in Diseases of Infants and Children (including Infant
Feeding) 20
^Massage 10
Principles of Ethics 10
Total... . 60
* When two or more groups are brought in during the first year, it will be
necessary to repeat most of the subjects in the first year with each group, so
that all may be ready to enter for the second year's work together.
THE COURSE OP STUDY 39
Second or Spring Term
Gynecological Nursing 10
Orthopedic Nursing 10
Operating- Room Technic 10
Obstetrical Nursing 20
Nursing in Diseases of the Eye, Ear, Nose and Throat 10
Total 60
Senior or Third Year
First or Winter Term
Nursing in Mental and Nervous Diseases 20
Nursing in Occupational, Venereal and Skin Diseases 10
Special Therapeutics (including Occupation Therapy) 10
Public Sanitation » 10
Survey of the Nursing Field 10
Total 60
Second or Spring Term
Modern Social Conditions 10
Professional Problems 10
Emergency Nursing and First Aid 10
"Introduction to Public Health Nursing and Social
Service 10 hours
"Introduction to Private Nursing 10 hours
"Introduction to Institutional Work 10 hours
"Introduction to Laboratory Work 10 hours
"Housekeeping Problems of Industrial Families 10 hours
"Special Disease Problems (Advanced work in any of
special forms of disease studied above) 10 hours
Total 60
Total number of hours for the three years — 585 to 595.
The outline of each of these subjects is given in the following pages. The
subjects are classified according to their relationship to one another rather
than in the order in which they would follow one another in the curriculum.
They are divided into the main fields of Biological and Physical Science, House-
hold Science, Prevention of Disease, Treatment of Disease, Nursing in Dif-
ferent Forms of Disease, Social and Professional Subjects and Special Branches
of Nursing.
* The subjects starred are all elective, to be selected according to the stu-
dent's future line of work. Each student would be expected to cover at least
three of these subjects, to make up a total of 60 hours of work for the last term.
30
OUTLINES OF SUBJECTS
A. BIOLOGICAL AND PHYSICAL SCIENCES
Anatomy and Physiology
TIME: 60 hours, divided as follows:
Lectures and demonstrations by qualified teacher of anat-
omy, preferably a physician or trained nurse instructor, 30
hours.
Classes, quizzes and individual laboratory work conducted
by nurse instructor, 30 hours.
Course to be given (and completed) in the early part of the
first year.
OBJECTS OF THE COURSE
1. To give the pupil a practical working knowledge of the
structure and function of the normal human body as the essen-
tial basis for the study of hygiene, dietetics, materia medica,
and all pathological conditions, as well as for the safe and in-
telligent practice of nursing measures in the wards.
2. To discourage popular, haphazard and pseudo-scientific
ways of thinking about the body and its functions, to give
practice in the correct use of ordinary scientific terms, to train
in habits of exact observation and reasoning and to arouse an
intelligent interest in scientific work generally.
OUTLINE OF CLASSES AND LABORATORY PERIODS
I and III. (Lectures and Demonstrations) Introduction.
Biological functions common to all forms of life — Eight biologi-
cal systems — skeletal, muscular, alimentary, vascular, respi-
ratory, excretory, nervous, reproductive. Body as a whole —
cavities, surface anatomy, location of organs. The cell theory
— cell structure and activities. Evolutionary theory (very
briefly).
II and IV. (Laboratory and Quiz)
Dissect frog of larger animal to show body as a whole. Study
simpler animal types — amoeba and paramecium under micro-
scope. Show slides illustrating cell-division in diderent stages.
V and VII. (Lectures and Demonstrations) Study of Tissues
Embryonic origin of tissues. Four elementary tissues — epi-
thelial, connective, nervous, muscular. Glandular tissue — flat
and columnar cells, tubular glands, branched tubular glands.
Special membranes — serous, synovial, mucous, cutaneous.
VI and VIII. (Laboratory and Quiz)
Charts or pictures showing folding off of tissues in embryo.
Students make slides of epithelial tissue from the lips. Stain
and examine under the microscope. Draw. Illustrate dif-
40
ANATOMY AND PHYSIOLOGY 41
ferent tissues by meat obtained from the butcher or by dis-
secting small animal ; also show slides under microscope.
IX and XI. (Lectures and Demonstrations) Skeletal System
Osseous tissue — gross and microscopic. Structure of bone.
Regeneration of bone. Study of skeleton — head, trunk, ex-
tremities, articulations.
X and XII. (Laboratory and Quiz)
Examine and sketch slides showing longitudinal and trans-
verse sections of bone. Fresh bone, showing articulations.
Bone treated with acid. Quiz on skeleton and separate bones
to be studied and identified. (X-rays plates very helpful.)
XIII and XV. (Lectures and Demonstrations) Muscular System
Muscular tissue. Mechanics of locomotion. Muscular fa-
tigue. Study of more important muscles, particularly those
involved in common surgical procedures.
XIV and XVI. (Laboratory and Quiz)
Slides showing different types of muscular tissue. Charts
showing different types of levers. Examination of fresh meat.
Rabbit or cat dissection for muscles and tendons.
XVII, XIX, XXI, XXIII, and XXV. (Lectures and Demonstrations)
Alimentary System
Anatomy of alimentary canal. Anatomy of accessory organs
of the digestive system — teeth, tongue, salivary glands, pan-
creas, liver and gall-bladder. Foods, food constituents, body
constituents, food values. Digestion — mechanical, chemical
and psychical factors. Absorption.
XVIII, XX, XXII, -XXIV and XXVI. (Laboratory and Quiz)
Charts, models, slides and fresh specimens of animal organs
used freely. Government charts showing food values. Dem-
onstrate chemical tests in digestion and absorption of foods,
salivary digestion, gastric digestion and saponification of fats
and oils. X-ray plates showing bismuth meals. (For full
directions as to tests see Bigelow — Applied Biology and Labora-
tory Manual.)
XXVII, XXIX, XXXI, and XXXIII. (Lectures and Demonstrations)
Vascular System
Blood-vascular system — blood, heart, arteries, veins and
capillaries. General circulation — pulmonary, systemic and
pSrtal. Control of local circulation, blood pressure, pulse.
Lymph-vascular system — lymph, lymph-vessels.
XXVIII, XXX, XXXII and XXXIV. (Laboratory and Quiz)
Show charts, models, slides and diagrams. Dissect beef
heart with vessels. Students make slides of drop of their own
blood; examine, make drawings. Show method of counting
r. b. c. and leucocytes. Effect of different solutions, tempera-
tures, etc. on clotting. Demonstrate taking blood-pressure.
Pulse-tracings in normal and abnormal cases. Examine foot of
live frog under microscope for study of circulation and heart
action in dead frog. Color index for haemoglobin.
42 OUTLINES OF SUBJECTS
XXXV and XXVII. (Lectures and Demonstrations) Respiratory System
Anatomy of respiratory organs. Function of respiration.
Mechanical factors. Effect on blood.
XXXVI and X CXVIII. (Laboratory and Quiz)
Examination, inflation and dissection of beef lungs, includ-
ing trachea and larynx. Microscopic study of lung tissue.
Demonstrate mechanics of respiration. Demonstrate lung-
motor. Test students' lung capacity.
XXXIX, XLI and XLIII. (Lectures and Demonstrations) Excretory
System
Anatomy of kidneys, ureters, bladder, etc. Physiology of
urinary system. Anatomy and physiology of the skin. (Pri-
mary function heat regulation, secondary function excretion.)
Appendages of the skin — hair and nails. Body temperature —
normal, abnormal. Mechanism of heat regulation.
XL, XLII and XLIV. (Laboratory and Quiz)
Dissect sheep's kidney. Show charts, models, slides, etc., of
kidney and skin. Constituents of normal urine and simple tests.
XLV. (Lecture and Demonstration) Ductless Glands and Metabolism
Structure and functions of suprarenal, thyroid and pituitary
glands. Influence of internal secretions on functions of the
body. Metabolism. Anabolic and katabolic changes.
XLVI. (Laboratory and Quiz)
Examination of specimens and slides. Review of digestion,
excretion and metabolism.
XLVII, XLIX, LI, LIII, LV. (Lectures and Demonstrations) Nervous
System and Special Senses
Nervous tissue. Degeneration and regeneration of nervous
tissue. The neurone, the spinal cord, spinal nerves. Reflex
and automatic action. The brain — structure and function.
Sensation. Anatomy and physiology of special sense organs —
ear, eye, organs of taste and smell.
XLVIII, XL, LII, LIV and LVI. (Laboratory and Quiz)
Charts, models, and slides of brain, cord and special sense
organs. Dissection of fresh pig's head. Dissection of pig's
eye. Drawings.
LVIII, LIX. (Lectures and Demonstrations) Reproductive System
Anatomy of female generative organs. Review of pelvic
bones. Birth canal. Anatomy of male generative organs and
male pelvis. Physiology of the reproductive system.
LVIII and LX. (Laboratory and Quiz)
Show lantern slides or charts of different stages in develop-
ment of embryo. Dissect cat or rabbit to show embryo and re-
productive system as a whole.
METHODS OF TEACHING
1. In the lecture periods, groups of 30 pupils or more can be
handled, but for laboratory work, smaller groups not exceeding
15 to 20 are advisable.
ANATOMY AND PHYSIOLOGY 43
2. It is important to have pupils themselves handle material
and carry out observations and experiments as far as at all
possible. Laboratory work arouses interest, stamps facts in
the memory, trains in careful observation and clears up difficul-
ties. Clear written directions should be given for all laboratory
exercises. Pupils can often work in groups of two or three,
where the material and equipment is limited. Note books of
laboratory work should be kept with diagrams and drawings,
descriptions of experiments, etc. These should be handed in
for inspection at regular intervals.
3. Where the time is limited, demonstrations by the teacher
may take the place of some of the laboratory exercises. Some
teachers advocate the observation of one or two post-mortems
for pupils in anatomy classes, but this would probably come
more profitably in the later part of the training.
4. Short papers on special topics can be assigned to pupils
in turn, and read in class. Oral and written quizzes and reviews
should be frequent.
5. Special emphasis should be laid on the phases of the sub-
ject which apply to nurses' work. The close connection be-
tween the theoretical and the practical work should be empha-
sized, and illustrations should be used constantly by the in-
structor to form a close association between the two. The
work here should also be correlated with parallel courses in
chemistry, bacteriology, hygiene, dietetics, etc.
6. Good blackboard work is essential here. A good-sized
blackboard and colored chalks should be provided. Students
should be encouraged to use diagrams extensively in note-books
and should also learn to draw on the blackboard.
7. A good text book should be used, and assignments required
regularly. Other readings can be assigned where the text-
book needs to be supplemented.
8. Take students to a good Natural History Museum if pos-
sible, to show comparison between human anatomy and that
of other animals; also to show cellular structure and embryonic
development.
9. It is not expected that this arrangement of topics will
suit all teachers. Many prefer to take the skeletal and muscu-
lar systems before tissues, some introduce the nervous system
much earlier in the course, and some take the circulatory sys-
tem before the digestive. Such readjustments in the order
of topics would not alter the general character of the course.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Skeleton with separate skull, separate bones; compound and
dissecting microscopes (one for every two students if possible),
colored chalks, charts, slides and X-rays plates; papier-mache
manikin and models of kidney, sweat glands, eye, ear, etc.
44 OUTLINES OF SUBJECTS
Specimens in formalin — brain, kidney, spinal cord, larynx, etc.
Modelling clay. Excellent home-made charts can be made with
manilla paper and wax crayons, or with Bristol board and paints
or water colors.
MATERIALS TO BE KEPT IN CLASS-ROOM (for a group of 12) :
Two trays, 6 dissecting pans with paraffin (squares of soft
wood may be used instead of paraffin pans); flat glass dishes;
6 finger bowls; 6 small glass jars; 12 dissecting needles; paper
pins (small); bank pins; 8-in. square gauze; 6 glass stoppered
bottles; 6 Bunsen burners; 6 tripods; 6 wire-screens; 3 small
alcohol lamps; slides; cover slips; glass covered jars for speci-
mens; labels; 3 red wax pencils; 3 doz. text-tubes, 6 glass fun-
nels (2 sizes); filter paper (2 sizes); 6 sets of beakers (4 in set)
6 funnel racks; 6 test-tube racks; 6 test-tube holders; stickers;
cotton thread; No. 36; dishes for specimens; 3 casseroles; 2
mortars and pestles; litmus paper; HC1 0.2 per cent, HC1 10
per cent; Fehling-Benedict solution; Filter paper; Iodine;
NaOH; Alcohol; 6 glass stirring rods; 6 pipettes; 6 scalpels;
6 pr. scissors (those discarded from operating room may be
used, or scissors may be bought at the ten cent store); 10 per
cent formalin.
TEXT AND REFERENCE BOOKS
Kimber: Anatomy and Physiology for Nurses.
Pope: Anatomy and Physiology for Nurses.
Dawson: Anatomy and Physiology for Nurses
Bundy: 'Anatomy and Physiology.
Howell: Text-book of Physiology.
Starling: Principles of Human Physiology.
Tigerstedt: Text-book of Physiology.
Hough and Sedgwick: Human Mechanism.
Martin: Human Body.
Bigelow: Applied Biology.
Halliburton: Hand-book of Physiology.
Brubaker: Anatomy and Physiology.
Hertar: Biological Aspects of Human Problems.
Cannon: Mechanical Factors in Digestion.
Cannon: Bodily Changes in Pain, Hunger, Fear and Rage.
Parker and Parker: Practical Zoology.
Parker and Haswell: Text-book of Zoology.
Gray: Anatomy.
Gcrrish: Anatomy.
Sabotta-McMurrich: Atlas and Text-book of Human Anatomy.
Marshall: Vertebrate Embryology.
Wiedersheim : Comparative Anatomy.
Piersol: Normal Histology.
BACTERIOLOGY 45
Hill: Histology.
Stiles: Nutritional Physiology.
Sherman: Chemistry of Food and Nutrition.
Elementary Bacteriology
TIME: 20 hours — arranged as follows:
Lecture, demonstration, and recitation 10 hours.
Laboratory work — 10 hours. (Laboratory period to follow
class period.)
Taught by a physician with nurse assistant, or by trained
nurse instructor. The course to be given early in the pre-
paratory year.
OBJECTS OF COURSE
1. To help pupils to understand the characteristics and hab-
its of microorganisms, so that they may be better able to
protect themselves, their patients, and the public from
infection.
2. To teach them something of laboratory technic so that
they will appreciate better the necessity for surgical asepsis,
and learn to apply the same careful methods in their nursing
procedures, cleaning, cookery, etc.
3. To arouse interest in this new and very important branch
of science, so that the pupils will continue to read and study
along these lines, and keep up-to-date in the latest discoveries
and methods.
OUTLINE OF CLASSES AND LABORATORY WORK
I. (Class) Introduction
Uses of bacteriology to the nurse. Historical theories of dis-
ease. Leaders in science of bacteriology — Pasteur, Koch, Er-
lich, etc. (very briefly). Consideration of plants — green and
colorless. Eight biological systems of higher animals and
parallel functions of one-celled organisms. Structure of typi-
cal plant and animal cells. Independent plants. Economic
and biological functions of green plants. Photo-synthesis,
respiration and transpiration. Reproduction by mitosis.
Conditions favoring growth.
II. (Laboratory) The microscope — how to use it and care for it.
Demonstration showing osmosis. Study of onion epidermis to
show cell structure and plasmolysis. Microscopic study show-
ing cell structure of leaves. Experiments showing photo-
synthesis, respiration and transpiration.
III. (Class) Molds
Dependent plants — molds, parasitic and saprophytic organ-
isms. Economic relationships. Mold diseases. Distribution
of molds. Structure. Reproduction' — sexual and asexual,
46 OUTLINES OF SUBJECTS
spore formation. Conditions favoring growth and methods of
destruction.
IV. (Laboratory) Study of two or three common molds under
microscope with drawings. Making of pure cultures of mold
by inoculating sterile bread or crackers with a selected mold.
V. (Class) Yeasts
Economic relationships. Structure. Reproduction by bud-
ding, fission and spores. Enzyme action. Fermentation.
Work of Pasteur. Conditions favoring growth. Methods of
destruction.
VI. (Laboratory) Observation and drawing of yeast cells and
starch grains. Technic of the hanging drop. Experiment to
show effect of different temperatures on growth and viability
of yeast or experiment to show ability of yeast to ferment
various carbohydrates.
VII. (Class) Bacteria
Distribution of bacteria. Structure of bacterial cell. Clas-
sification according to morphology and grouping. Methods of
reproduction by fission and by spore formation. Conditions
affecting growth — temperature, moisture, food supply, light,
oxygen. Effect of electricity, chemicals, agitation, etc. Vital
phenomena — odor, motility, light, heat, pigment, etc. Special
media for laboratory study of bacteria.
VIII. (Laboratory) Exhibit of various laboratory media. Descrip-
tion of culture growth. Making of agar pour plate and exposing
to various conditions as air, hair, fly, washed and unwashed
fingers, etc. Use of oil immersion lens. Preparation and ex-
amination of stained smear of bacteria from teeth. Examina-
tion of prepared slides of staphylococci, streptococci, and
bacilli for morphology.
IX. (Class) Effects of Physical and Chemical Agents on Micro-
organisms
Methods of destroying bacteria. Physical — by dry and moist
heat, sunlight, etc. Chemical — by germicides and antiseptics.
Length of exposure for bacteria and spores. Effects of strength
and temperature of chemical agents on bacteria.
X. (Laboratory) Examination of cultures from Lesson VIII.
Making pure culture by fishing and transferring to broth cul-
ture. Testing results of common physical and chemical agents
on bacteria.
XI. (Class) Bacteria and Disease
Disease production by toxins, endotoxins, and ptomaines.
Avenues of entrance into body of bacteria. Growth in tissues.
Avenues of discharge. Special study of the colon and typhoid
groups of bacteria.
XII. (Laboratory) Examine broth culture from laboratory X for
characteristic growth of organisms in broth. Make streak cul-
BACTERIOLOGY 47
ture on agar slant. Demonstration of plating method in
examination of water.
XIII. (Class) Dissemination of Disease-Producing Organisms
Transmission of disease by direct and indirect contact. The
r61e of insect carriers, human carriers, fomites, water, shell-
fish, milk and other foods, air and "filth." Special study of
staphylococcus, streptococcus, pneumococcus and filterable
viruses.
XIV. (Laboratory) Examination of streak cultures from laboratory
XII to identify organisms, purity of colonies, etc. Prepara-
tion and examination of slides of streptococcus, staphylococcus
and pneumococcus. Making cultures of water and milk.
XV. (Class) Bacteriology of Milk and Water
Relation of bacteria to milk supply. Sources of bacterial
infection in milk. Methods of safe-guarding milk supply.
Water as a medium of infection. Sources of contamination.
Tests for water and milk supplies.
XVI. (Laboratory) Examination of cultures of water and milk and
estimation of number to cubic centimeters of water or milk
tested. (Visit to Board of Health Laboratory if possible.)
XVII. (Class) Defences of the Body Against Pathogenic Bacteria
External defences of the body. Vital resistance and factors
modifying it. Theories of immunity, antibodies, phagocytes,
etc. Vaccination. Use of antitoxines and sera. Special study
of tubercle, Klebs-Loffler, tetanus and anthrax bacilli. Prepa-
ration of sera and vaccines. (Seen in laboratory if possible.)
XVIII. (Laboratory) Hanging drop showing motility and agglutina-
tion. Examination of prepared slides of bacilli given special
study in class, also slides showing phagocytosis.
IX. (Class) Applications of Bacteriology
Applications of above principles to methods of disinfection,
to sterilization of water, instruments, dressings, to care of dis-
charges and excretions. Applications of bacteriology and se-
rum-therapy in prevention, diagnosis and treatment of small-
pox, typhoid, fever, diphtheria, syphilis, rabies, etc. Special
study of organisms causing malaria, syphilis and gonorrhoea.
XX. (Laboratory) Demonstration of the taking of throat cultures.
Preparation and examination of smears from throat. Examina-
tion of prepared slides showing organisms discussed in class.
METHOD OF TEACHING
1. Follow class method for presentation of subject matter as
far as possible. Have outside readings and reports from as-
signed books or current journals.
2. Laboratory work to be given in sections, not exceeding
15 to 20 students with facilities for each pupil or pair of pupils
carrying out all the experiments. Note-books for drawings and
laboratory notes.
48 OUTLINES OF SUBJECTS
3. Correlate as closely as possible with other subjects, espe-
cially with hygiene and practical nursing work. A short paper
on "The Practical Applications of Bacteriology to Nursing"
will help to focus attention on the uses of the subject.
4. No one text book for nurses covers the ground adequately.
Choose the best and supplement liberally from larger reference
books. Recent editions of text and reference books should be
used, as changes are constantly taking place in this subject.
5. Have at least one visit to a well-equipped laboratory such
as might be found in the Board of Health — or the hospital itself.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Microscopes — (one for every two students if at all possible),
petri dishes, test tubes, fermentation tubes, slides (plain and
prepared), racks for drying slides, cover slips, stains, oil, balsam,
lens paper, platinum needles, bunsen burners, tripods, pipettes,
etc. Small utensil sterilizer, culture media and cultures from
pathological laboratory. Charts, photographs and slides.
Room should be fitted up with tables or shelves where mi-
croscopes can be placed in good light. Should also have gas
and running water attachments.
TEXT AND REFERENCE BOOKS
Conn: Bacteria, Yeasts and Molds in the Home.
Bolduan and Grund: Applied Bacteriology for Nurses.
Roberts: Bacteriology and Pathology for Nurses.
Fox: Bacteriology and Protozoology.
Buchanan: Household Bacteriology.
Curtis: Nature and Development of Plants.
Bigelow: Applied Biology.
Conn: Agricultural Bacteriology.
Hiss and Zinnser: A Text Book on Bacteriology.
Park and Williams: Pathogenic Micro-Organisms.
Jordan: General Bacteriology.
Zinnser: Infection and Resistance.
Chapin: The Sources and Modes of Infection.
Marshall: Microbiology.
Rosenau: Preventive Medicine and Hygiene.
Gibson: Clinical Laboratory Technic.
Carey: A Text-book for Nurses in BacteriologE.
Applied Chemistry.
TIME: 20 hours divided as follows:
Lecture and class-work — 10 hours.
Laboratory work and demonstrations — 10 hours.
Taught by the instructor of nurses or a teacher of chemistry
(secured from a high school or college) — Course to be given
early in the preparatory year.
CHEMISTRY 49
OBJECTS OF COURSE
1. To serve as a basis for the more intelligent study of physi-
ology, dietetics, household economy, materia medica, and other
nursing subjects.
2. To make the pupil nurse more observant of the chemical
phenomena of every-day life, especially those chemical reac-
tions which are of practical and economic importance in nurs-
ing and hospital work.
3. To train her to be skillful and accurate in handling labora-
tory material and to be exact in her reasoning.
4. Where pupils have already had a good course in chemistry,
the special applications of chemistry to nursing can be enlarged
upon and the general principles of organic and inorganic chem-
istry reviewed.
NOTE : It is highly desirable that all pupils should be required
to have covered a good elementary course in chemistry before
admission to nursing schools. It is quite impossible to teach
a subject of this kind in 20 hours. All one can hope to do is to
give a few foundation principles, and a few practical applica-
tions in this time.
OUTLINE OF CLASSES AND LABORATORY WORK
I. (Lecture and Class) Introduction
Relation of chemistry to animal life. Changes involved in
life processes. Relation to plant life. Classes of changes —
physical and chemical. Definitions of physics, chemistry, etc.
Factors in all energy changes — matter changes — mechanical
mixtures — chemical compounds — elements.
II. (Laboratory)
Construction of simple laboratory apparatus and experiments
showing physical and chemical changes.
III. (Lecture and Class) Elements and Chemical Formulae and Equa-
tions
Definition of elements — occurrence, physical states, names
and symbols of those in most general use. Dalton's Atomic
Theory. Valence. Molecules. Uses of formulae and equa-
tions. Study of formulae of compounds in most general use.
IV. (Laboratory) Mechanical and chemical compounds. Physical
processes. Dissolving — true solution and saturated solution.
Distillation (to be given as a demonstration).
V. (Lecture and Class) Oxygen
Occurrence, properties, importance to life. Oxidation.
Measuring of food value in terms of calories. Oxidizing and
reducing agents. Compounds of oxygen. Carbon dioxode.
Carbon monoxide. Water. Impurities of water — hard and
soft. Fire extinguishers.
50 OUTLINES OF SUBJECTS
VI. (Laboratory) Experiments in preparation of oxygen, showing
combustion. Determination of carbon dioxide. Tempera-
ture. Scales for measuring. Freezing and boiling points.
VII. (Lecture and Class) Acids
Composition. Brief talk on properties of hydrogen. Non-
metals — their classification. The acid radical. Formulae of
acids in most common use. Characteristics of acids. Classi-
fication of acids into binary acids, oxy-acids and halogen acids.
Action of acids on tissues.
VIII. (Laboratory) Test for characteristics of acids — taste, litmus
reaction, reaction with zinc, reaction with carbonates. Tests
for the presence of hydrogen.
IX. (Lecture and Class) Bases
Composition. Mention of some of the most important met-
als. Hydroxyl group. Definition of alkali. Characteristics
of bases. Classification of bases. Neutralization.
X. (Laboratory) Composition and preparation of lime water.
Test for characteristics of bases, litmus reaction, taste, feeling,
neutralization.
XI. (Lecture and Class) Salts
Classification of salts. Normal or neutral salts. Salts of
binary acids, oxy-acids, hypo-ous acids. Importance of salts
to the body. Uses of normal saline. Brief discussion of salts
used medicinally. Classification. Chlorides. Sulphates.
Phosphates. Halogen salts. Functions of special salts — cal-
cium, etc.
XII. (Laboratory) Experiments to show effect of distilled water on
blood. Test for reaction of salts — sodium chlorides, sodium
bicarbonates, acid sodium phosphates, etc. Tests for presence
of chlorides, sulphates, phosphates, etc.
XIII. (Lecture and Class) Introduction to Organic Chemistry
Definition. Constituents of organic compounds. Distribu-
tion of carbon. A few of the compounds of carbon. Organic
acids — their classification. Properties similar to inorganic
acids. Organic bases. Alcohols and alkaloids. Organic salts.
XIV. (Laboratory) Experiments to show constituents of organic
matter. Tests for presence of carbon, hydrogen, nitrogen, sul-
phur, phosphorus, etc. Tests for presence of alkaloids.
XV. (Lecture and Class) Carbohydrates
Molecular construction. Classification into monosaccharids,
di-saccharids and poly-saccharids. Their solubility, digestibil-
ity, properties and occurrence. Digestion of carbohydrates.
XVI. (Laboratory) Test for presence of glucose. Determination of
the composition of di-saccharids and poly-saccharids. Deter-
mination of elemental composition of carbohydrates. Salivary
digestion. Hydrolysis. Fermentation. Osmosis.
CHEMISTRY 51
XVII (Lecture and Class) Proteins
Nitrogen and some of its compounds (very briefly discussed).
Molecular construction of proteins. Classes of proteins —
where found. Digestion of proteins. End waste products of
protein metabolism.
XVIII. (Laboratory) Tests for presence of protein. Nitric acid test.
Biuret, precipitation test. Coagulation test for albumen.
Determination of nitrogen as ammonia. Preparation of pro-
teose and peptone. Test for urea.
XIX. (Lecture and Class) Fats
Use of fats to the body. Caloric value of fats. Molecular
construction. Fatty acids. Emulsions. Soaps. Alcohols.
XX. (Laboratory) Experiments showing solubility of fats in water,
alcohol, ether. Determination of glycerine. Extraction of pure
fat from beef suet. Saponification with an alkali. Emulsifica-
tion (Cod liver oil and NaC03). Separation of fatty acids.
METHODS OF TEACHING
1. It is impossible to teach chemistry by the lecture method
alone. Discussions and frequent quizzes are necessary to clear
up the difficult points and the demonstration of experiments is
essential to any clear understanding of the simplest principles
of chemistry. As far as at all possible each individual should
be able to work out her own experiments in the laboratory.
Where this is not possible a good deal can be accomplished
through demonstrations by the teacher.
2. In the laboratory stress is placed on the care with which
experiments are set up, and on the keenness of observation, the
accuracy of records and conclusions to be drawn. Before pass-
ing on to another experiment, each student is quizzed by the
instructor to be sure that she understands thoroughly what she
has done, and connects it with her notes.
3. Not more than 16 to 20 can be taken together in a labora-
tory section, unless one has unusual facilities. Students may
often work in groups of two.
EQUIPMENT
1. The room for the laboratory work should be well venti-
lated and fitted with a hood for carrying away odors of disagree-
able gases. This last is not indispensable. A large stationary
table with drawers and cupboards for each student, fitted with
running water and gas burners, is desirable, though one can
manage with one sink and alcohol lamps.
2. Apparatus, provided for laboratory groups of 12 pupils
working in pairs (cost is approximate only) : 6 500 cc. flasks,
$3.15 per dozen, 6 two-hole rubber stoppers No. 5 at 15 cents
each, 6 thistle tubes at 25 cents each, 1 pound glass tubing,
52 OUTLINES OF SUBJECTS
3/16 (25 2-foot length) at $1.10 pound, 6 ignition tubes at 10
cents each, 6 rubber stoppers, No. 1, at 92 cents dozen, 12 wide
mouth bottles at 11 cents each, 6 cake tins at 10 cents each, 6
deflagrating spoons at 45 cents each, 12 watch glasses at $2.00
per 100, scales and weights $10.50, 6 porcelain crucibles with
cover, at 40 cents each, 6 evaporating dishes (2 oz.) at $3.00 per
dozen, 6 asbestos mats at 25 cents each, 6 retort stands (three
rings) at $1.35 each, 3 dozen test tubes at $3.15 per gross, 6 test
tube holders at 32 cents each, 6 test tube racks at 90 cents each,
6 glass stirring rods at 40 cents dozen, 1 file (triangular) at 50
cents, 6 horn spoons (4^ in.) at $1.50 dozen, 6 pipettes at 5 cents
each, 1 nest beakers at $2.25 nest, 3 graduates (10 cc.) at 46
cents each, 3 graduates (50 cc.) at 96 cents each, filter paper
(4 in.) at 11 cents package, 3 mortars and pestles at 60 cents
each, 6 funnels (3 in.) at 35 cents each, 12 test tube brushes at
65 cents dozen, 1 Centigrade thermometer at $1.67.
TEXT AND REFERENCE BOOKS
McPherson and Henderson: Elementary Study of Chemistry.
Vulte: Household Chemistry.
Asher : Chemistry and Toxicology for Nurses.
Bliss and Olive: Chemistry for Nurses.
Amoss: Chemistry for Nurses.
Pope : Physics and Chemistry for Nurses.
Lynde: Household Physics.
B. HOUSEHOLD SCIENCE
Nutrition and Cookery
TIME: 40 hours, given in 20 two-hour periods, each period to include class,
demonstration and laboratory work. Class to be conducted by
a trained dietitian. Course to be given in the first term of the
Preparatory Year.
OBJECTS OP COUBSE
1. To give pupils a good fundamental understanding of the
principles and methods of simple cookery for well and sick
people.
2. To make them familiar with the nutritive values of foods,
and help them to arrange a balanced dietary for well people
or convalescents according to the demands of age, physical ac-
tivity, climate, etc.
3. To help them to understand and administer the ordinary
hospital diets. (Dietary treatment of particular diseases to
come later.)
OUTLINE OF CLASSES
I. (Class) Introduction
Definition of food. Chemical composition of the body and
of food. Classification of foods, according to sources (animal,
vegetable, and mineral) and according to chemical composi-
tion (proteins, carbohydrates, fats, mineral salts and water).
Function of each of these in the body.
(Laboratory) The diet kitchen and its equipment. Care of
utensils and apparatus, sinks, refrigerators, etc. Study of
stoves and fuels. Uses of each kind.
II. (Class) Digestion
Review of the digestive system, and processes of digestion,
absorption, assimilation, excretion and metabolism. Effect of
methods of cooking and preservation of food on digestion.
(Laboratory) Temperatures and methods of cooking and
their effect on food stuffs (baking, boiling, broiling, frying,
etc.). Handling of utensils — measuring and weighing.
III. (Class) Fuel Values in Foods
Basis of measurement of fuel values. The body requirement
in health according to variations of sex, age, weight, activity,
climate, etc. General variation in illness. How to compute
the caloric value of different kinds of foods.
(Laboratory) Practice in measuring out 100-calorie portions
of common carbohydrates, sugars, fats and proteins. (Metric
system.)
53
64 OUTLINES OF SUBJECTS
IV. (Class) Building Materials in Foods
Basis of measurement of protein in foods. The body require-
ment of protein according to sex, age, weight, activity, etc.
Variations in illness. How to compute the protein content of
common foods. Comparison of digestibility and costs. Body
requirement in mineral salts and water.
(Laboratory) Practice in weighing and computing protein
content of foods, also mineral salts and water.
V. (Class) Preparation and Serving oj Foods
General principles in the feeding of sick people. Selection
of food, preservation and handling, considerations of taste,
variety, digestibility, appearance, nutritive value and economy.
Table and tray equipment for serving food — dishes, linen, sil-
ver, decorations, etc. Principles of tray service. The con-
valescent table.
(Laboratory) Practice in setting table and tray for break-
fast, dinner, luncheon, and light diet.
VI. (Class) Beverages
Place of water and beverages in the dietary. Sources, varie-
ties, composition and preparation of stimulating and acid bev-
erages. Mineral waters — uses, kinds and methods of serving.
(Laboratory) P ac ice in preparing and serving tea, coffee,
cocoa, fruit drinks, wines and mineral waters.
VII. (Class) Cereals, Gruels and Starchy Drinks
Composition and food value of common cereal foods. Cook-
ery of starches, especially breakfast cereals and gruels, with
special reference to digestibility.
(Laboratory) Various preparations of oatmeal, wheat, hom-
iny, rice, barley, etc. Starchy beverages.
VIII. (Class) Vegetables
Composition and fold value of common legumes, roots and
green vegetables. Selection, preparation and cooking.
(Laboratory) Practice in preparation of potatoes, spinach,
beans, cauliflower, celery, etc.
IX. (Class) Fruits and Sugars
Composition, sources, kinds and food value of common fruits
and sugars. Selection, preparation and cooking.
(Laboratory) Preparation of common fresh, dried and
canned fruits.
X. (Class) Fats and Oils — Salads
Place of fats in the dietary. Comparison of animal and
vegetable fats. Use of fats in cooking. Food value of nuts.
Varieties of salads and salad dressings.
(Laboratory) Practice in making fruit and vegetable sal-
ads and salad dressings.
XI. (Class) Protein Foods— Milk
Milk as a food. Its production and handling. Principles
observed in the cooking of milk. Combinations of milk with
NUTRITION AND COOKERY 55
cereals and vegetables. Forms of serving raw milk. Principles
of pasteurization.
(Laboratory) Preparation of milk soups, milk gruels, milk
shakes, milk punches. Pasteurized milk.
XII. (Class) Special Milk Products
Source and food value of cream, butter, cheese, curds and
whey. Composition and preparation of milk powder, con-
densed milk, malted and peptonized milk. Lactic acid prepa-
rations.
(Laboratory) Preparation of junket, cottage cheese, whey,
peptonized milk, koumiss and buttermilk.
XIII. (Class) Eggs
Composition, food value and digestibility of eggs. Tests for
freshness. Effects of temperature. Combinations of eggs with
milk, cereals, fruit juices, etc.
(Laboratory) Preparation of baked, boiled, scrambled and
poached eggs, omelet, custards, egg-nogs, and albumen water.
XIV and XV. (Class) Meats and Poultry.
Composition, structure, food value and digestibility of
meats. Different cuts and organs used as food. Tests for
freshness. Effects of temperature. Methods for extraction
and retention of juices. General principles of carving meat
joints and fowl.
(Laboratory) Preparation of roast, broiled and stewed
meats, poultry broth, beef juice and scraped beef. Carving.
XVI. (Class) Fish, Mollusks and Crustaceans
Classes of fish goods, composition, food value and digesti-
bility. Tests for freshness. Special dangers of shell fish.
(Laboratory) Preparation of baked, boiled and fried fish,
oysters and clam stews and broths, lobster.
XVII. (Class) Gelatines and Frozen Desserts
Composition, sources and food value of gelatine. Effect of
freezing on foods. Principles of freezing mixtures.
(Laboratory) Preparation of gelatine alone and in combina-
tion with other foods. Preparation of ice creams and sherbets.
XVIII. (Class) Breads (Leavening Agents)
Composition, food value and digestibility of various kinds of
breads. Leavening agents — such as yeasts, baking powders, etc.
and their action.
(Laboratory) Making bread and rolls, biscuits, sponge cake,
gluten bread, etc. Toast and sandwiches.
XIX and
XX. (Class) Hospital Diets
Classes of patients in hospital requiring specialized diet.
Modification of regular diet for children, adolescents and the
aged, also for chronics, convalescents, etc. Types of hospital
diets — fluid, light, nitrogenous, farinaceous, milk, etc.
66 OUTLINES OF SUBJECTS
(Laboratory) Making of menus for typical patients — not
acutely ill. Preparation and serving of complete meals, repre-
senting balanced normal diet and various types of special hos-
pital diets.
METHOD OP TEACHING
1. The most satisfactory method is the combination of class,
demonstration and laboratory in lessons of from two to three
hours each. The pupils then have a chance to tie up their prin-
ciples directly with their practice, and to carry out their cook-
ing procedures when the demonstration and discussion are
fresh in mind and when they are under direct supervision. The
number in the class should not exceed 20 pupils. Regular diet
kitchen experience would follow such a course of class and lab-
oratory work, and the pupil would then be able to proceed with
little additional instruction.
2. If such a method is impossible, classes and demonstrations
could be held by the dietitian, and the applications made later
when the pupil has her diet kitchen experience. This method
requires a great deal of individual instruction and supervision
in the diet kitchen, and there is danger of the practical and
theoretical side of the work not being so closely connected up.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
1. There is a great variety of illustrative material available
in the form of food charts, sample food products, models of
meat cuts, etc. (See list of firms, Appendix III).
2. A full equipped cooking laboratory is essential for the
satisfactory teaching of dietetics. For discussion of the plan
and equipment of such a laboratory, see Teachers College
Record, May, 1909.
TEXT AND REFERENCE BOOKS
Friedenwald and Rurah: Dietetics for Nurses.
Pope and Carpenter: Essentials of Dietetics.
Pattee: Practical Dietetics.
Hall : Nutrition and Dietetics.
McCollum: The Newer Knowledge of Nutrition.
Farmer: Foods and Cookery for the Sick and Convalescent.
Farmer: Boston Cook Book.
Rose: Handbook of Laboratory Dietetics.
Rose: Feeding the Family.
Barrows and Lincoln: Home Science Cook Book.
Pamphlets and Bulletins: Department of Agriculture.
Cornell and Teachers College Bulletins.
DIET IN DISEASE 57
Diet in Disease
TIME 10 hours divided as follows: — Lectures or classes given by a physi-
cian, nurse or dietitian — 5 hours. Demonstrations and labora-
tory work conducted by trained dietitian — 5 hours.
Course to be given in second term of the Preparatory Year.
OBJECTS OP COURSE
To apply the fundamental principles of cookery and nutri-
tion to the dietary treatment of the commoner diseases. In
each of the conditions mentioned below, general principles of
feeding are discussed, diet lists examined, menus made out,
food values computed, and typical diets prepared and served.
The charting of diets is also emphasized and the importance
of proper records, especially in metabolism studies. Infant
feeding is included under Diseases of Infants and Children
P. 100.
OUTLINE or CLASSES
I. Diet in diseases of the digestive system — gastritis, constipation,
diarrhoea, dyspepsia, gastric ulcer, dysentery, acute colitis,
appendicitis, gall-stones, gastric disorders. Test diets and
nutrient enemata.
II. Diet in fevers — slight infections, tonsilitis, pneumonia and
tuberculosis. Special typhoid diets, including the high caloric
feeding. Diet in convalescence.
III. Diet in anaemia, cardiac disorders, nervous and mental condi-
tions, obesity.
IV. Diet in nephritis, cystitis, calculus, rheumatism, gout, scurvy,
rickets and diabetes.
V. Diet in surgical cases — for control of nausea in peritonitis, in
laparotomies, head and mouth cases. Formulae used for feed-
ing through gastric and intestinal fistulas and by rectum.
(Each of these classes should be followed by a laboratory
period in the diet kitchen where all special diets would be
prepared.)
METHODS OF TEACHING AND ILLUSTRATIVE MATERIAL
As in preceding, course.
TEXT AND REFERENCE BOOKS
Carter and Howe: Nutrition and Clinical Diet.
Thompson: Practical Dietetics.
Sherman: Chemistry of Food and Nutrition.
Friedenwald and Rurah: Diet in Health and Disease.
(See also under Nutrition and Cookery)
58 OUTLINES OF SUBJECTS
Hospital Housekeeping
TIME: 10 hours. Classes, discussions, demonstrations and written re-
ports. Conducted by the instructor of nurses. Given in the
preparatory course. (Correlated practice work outside of this
time to be given in nurses' home and hospital departments.)
OBJECTS OP COURSE
1. To give the student a better understanding of the prin-
ciples and methods of good housekeeping and to make her ap-
preciate their fundamental importance in nursing work.
2. To enable her to exercise intelligence and economy in the
proper selection, use and care of the materials and equipment
relating to her work, and to develop a high degree of efficiency
in the technic and organization of housekeeping measures.
OUTLINE OF CLASSES
I. Introduction
Meaning of "Household Economy." The nurses' home as a
type of larger household. General plan. Relation of one de-
partment to another. Principles of efficiency and economy in
the household. Visit to various departments of the nurses'
home and talk on general regulations of the household. Care
of nurses' bed-room.
II. Cleaning and Polishing.
Materials to be cleaned — woods, paints, fabrics, metals,
glass, rubber, china, etc. Appliances and their care — brooms,
brushes, mops, etc. Materials — soaps, polishes, bleaches, etc.
Methods of sweeping, dusting, cleaning, scrubbing.
Practice. Daily cleaning of bed-room by each pupil. Clean-
ing of silver, brass, marble, etc.
III. Interior Furnishings and Finishings.
Materials of construction of floors — wood, tile, terrazzo,
cement, etc. Dressings and coverings — paints, oils, polishes,
linoleum, rugs, carpets, etc. Walls and ceilings — finish, paints,
paper, tile, etc. — materials and colors.
Practice. Thorough house-cleaning of bed-room.
IV. Equipment and Arrangement
The kitchen, pantry, living room, dining room, etc. Equip-
ment of each — use, cost, durability, artistic design, sanitary
aspect, etc. Arrangement from practical and artistic stand-
point.
Practice. Cleaning and arrangement of living room or
library.
V. Healing and Ventilating Systems
Types of heating — radiation, convection (steam, hot water,
hot air). Equipment — furnaces, boilers, ranges, stoves, grates,
HOSPITAL HOUSEKEEPING 59
electrical heaters. Fuels — wood, coal, oil, etc. Use of meters.
Ventilating systems — natural and artificial ventilation. Tele-
phone and electric bell systems. Fire escapes and use of fire
extinguishers. Fire drills.
Practice. Taking room temperature, ventilating rooms,
practicing fire drill, etc.
VI. Lighting and Plumbing Systems
Types of lighting — natural, artificial, direct, indirect. Equip-
ment— fixtures, lamps, etc. Cleaning and care. Systems of
plumbing. Water supply and sewage disposal — pipes, traps,
sink, lavatory equipment. Their cleaning and care.
Practice. Caring for lighting and plumbing fixtures. Clean-
ing sinks, bathrooms and lavatories in nurses' home.
VII. Disposal of Garbage and Household Pests
Methods of garbage disposal and hospital wastes. Special
precautions in the hospital . Insects found in food and clothing.
Insects injurious or disagreeable to people. Means of extermi-
nation. Protection of food supplies in the household.
Practice. Looking over garbage cans to discover sources of
waste. Cleaning of kitchen refrigerator, care of food supplies,
etc.
VIII. The Laundry
Purpose and plan of the laundry. Care of soiled linen.
Gathering linen — sorting, washing, bleaching, rinsing, man-
gling. Soap making. Equipment — washers, manglers, extrac-
tors, starch kettle, dryers, etc. Disinfection of linen. Removal
of stains. Washing things out by hand.
Practice. Pupil should spend a short period in the laundry,
should help in sorting linen and see all the processes at first
hand.
IX. The Central Linen Room, Sewing Room and Clothes Room
Purpose and plan of linen room — arrangement, inventory,
mending, marking, folding. Systems of replacement and
exchange. Care of linen closet in the wards. Care of patients'
clothing — cleansing and repair — disinfection, etc.
Practice. Looking over linen for mending, folding and stack-
ing linen, caring for linen closet, etc.
X. Hospital Supplies
Economy in the hospital. Necessity of conserving hospital
finances for necessary care of patients. Cost of hospital sup-
plies. Sources of waste. Methods of economy in standardiz-
ing hospital supplies and study of types and costs. Visit to
store room.
Practice. Making out lists of stores with costs — Making up
dressings and hospital supplies in supply room.
METHODS OF TEACHING
1. To make the course comprehensive the objects should as
far as possible, be placed before the students and attention
60 OUTLINES OF SUBJECTS
directed to points under discussion. Where this is not possible
cuts from catalogs may be used. Catalogs may be also used
to get prices of hospital supplies. Pupils should themselves
look these up and bring to class.
2. When possible the instructor should illustrate by demon-
strating or by taking pupils to the various departments and
showing them processes in operation. All students should have
an opportunity to carry out the practical procedures as soon as
possible after the lesson.
3. This instruction should be closely correlated with that of
chemistry, physics, bacteriology, hygiene, and sanitation. It
should, if possible, precede the course in practical nursing, and
might be given in daily classes during the first ten days as a
preparation for later work in the hospital.
4. Pupils may be assigned full care of their own rooms during
the preparatory course. Practice should also be provided in the
nurses' home, laundry, diet kitchen, supply room and other
departments of the hospital where the above principles can be
applied. The time spent in such work should be limited as it
is important only that pupils should get a good command of
fundamental processes and not that they should be employed
in routine household work.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Individual utensils and tools for work as far as possible.
Samples of flooring materials, cleaning agents, etc. Catalogs.
Illustrations from current magazines.
TEXT AND REFERENCE BOOKS
Parloa: Home Economics.
Richards: Home Sanitation.
Broadhurst: Home and Community Hygiene.
Campbell: Household Economics.
Terrill: Household Management.
Balderston: Laundry Manual.
Balderston: Housewifery.
Kinne and Cooley: Shelter and Clothing.
Putnam: Plumbing and Household Sanitation.
Butler: Household Physics.
Lynde: Physics of the Household.
Priestman: Art and Economy in Home Decoration.
Kittredgc: Practical Home Making.
U. S. Government Bulletins 1914— No. 37, 38, and 39.
Housekeeping Problems of Industrial Families ((Elective)
TIME: 10 hours. Classes, demonstrations, and excursions. Given by
a visiting nurse or a visiting housekeeper, with the possible
HOUSEKEEPING PROBLEMS OF INDUSTRIAL FAMILIES 61
assistance of the hospital dietitian. To be given in the latter
part of the third year.
OBJECTS OF THE COURSE
This course is intended for pupils who expect to go into
families either as private or public health nurses. It is de-
signed to help them to understand the economic problems of the
family of limited income, and to enable them to give assistance
and advice in matters pertaining to the proper feeding and
care of the household.
OUTLINE OF CLASSES
I. The Household Budget
The varying costs of living as indicated by budget studies.
The value of a budget in helping towards a wiser planning of
expenditures, and a more thrifty use of the income. Methods
and standards to be followed in estimating a budget for a
family.
Assigned work. Planning a weekly budget for a family of a
certain size and income.
II. Housing Standards and Costs
The importance of good housing. Characteristics of a satis-
factory house from the health standpoint. Proportion of
income ideally to be used for rent. Rents which are charged
in the vicinity in relation to wages being paid.
III. Food Costs
Variations in the cost of food per person, as indicated by
"cost of living" studies. Minimum standards for food expendi-
tures. Characteristics and limitations of a low cost dietary.
Assigned work : Planning very inexpensive meals for a family
for a day, reckoning food value and cost.
IV. Food Selection and Care.
Importance of buying clean food in a clean store, and caring
properly for it in the home. Points to be considered in select-
ing inexpensive meat, fish, fruits, vegetables, cereal products,
etc. (Trip to market or food store if at all possible.)
V. Reducing\Food Costs
Value of planning meals ahead; buying in person for cash, in
as large quantities as practicable ; cooking food when possible
rather than using prepared products; choosing food which will
give largest nutritive return for the money; keeping household
accounts. Using fireless cooker, iceless refrigerator, and other
appliances which make possible low cost cooking and low cost
caring for food.
VI. Racial habits and customs, climate, and other factors which influ-
ence dietary selection (with special reference to the feeding
of children.)
62 OUTLINES OF SUBJECTS
Characteristics of Italian, Russian, Jewish, Polish, Irish,
German and Negro dietaries. Changes to be advised if found
inadequate under local conditions. The dietary in the rural
and urban community; winter and summer dietaries as illustra-
tive of the dietary of cooler and warmer climates. Food
requirements at different ages.
VII. Special Diets in (he Home
Planning the home diet of tubercular and diabetic patients,
expectant mothers and others requiring marked variation of
the ordinary family dietary.
VIII. Clothing Standards and Costs
Hygienic essentials in clothing for men, women and children.
Minimum costs for clothing. Economics in the purchasing of
clothing which might be practised.
IX. Laundering and Housekeeping Methods
The importance of cleanliness in the home. Relative values
in laundering and cleaning supplies. Labor saving devices
and methods.
X. Household Management and Thrift.
The importance of system in household management, especi-
ally as it affects the care of children or a sick person. Methods
of planning and organizing household tasks. The importance
of thrift which will make possible the saving towards sickness
or other household emergency.
METHOD OF TEACHING
1. The most satisfactory way is to have the pupil study
individual families with the object of assisting them in working
out a satisfactory budget on an economic basis. Such work
might be done through the social service department, a visiting
nurse association, or a charity organization society.
2. Individual or class visits to tenements stores and markets
in various parts of the city are also exceedingly helpful in get-
ting a clear picture of sanitary conditions and the housing and
shopping problems of the family.
3. Plenty of outside practice in making out menus and
dietaries for typical cases should be provided.
ILLUSTRATIVE MATERIAL AND EQUIPMENT (see Cooking and Dietetics)
Local dealers' catalogs and market guides can also be used
to good advantage.
TEXT AND REFERENCE BOOKS
Streightoff : Standard of Living.
Chapin: Standard of Living in New York City.
Nearing: Financing the Wage Earner's Family.
Gibba: Lessons in Feeding the Family.
HOUSEKEEPING PROBLEMS OF INDUSTRIAL FAMILIES 63
Nesbitt: Low Cost Cooking.
Jaffa: A Standard Dietary for an Orphanage.
Rose: Food for School Boys and Girls.
Rose: Feeding the Family.
Langworthy: Food Customs and Diet in American Homes.
U. S. Dept. Ag., Bulletin 110.
Hills and others: Dietary Studies in Rural Regions. U. S.
Dept. of Agriculture, Bulletin 221.
Rose: Cost of Food. Cornell Bulletin, Food Series No. 7.
American Home Economics Association : Thrift by Household
Accounting.
C. PREVENTION OF DISEASE
Personal Hygiene
TIME: 10 hours. Classes conducted by the instructor of nurses. Given in
the early part of the preparatory course. (Supplemented by a
course of physical exercises in a gymnasium if at all possible —
otherwise the simple exercises given in Appendix IV might
be taught by the instructor in connection with the hygiene
classes.
OBJECTS OF COURSE
1. To impress upon the pupil nurse the paramount importance
of good health, and to help her to protect herself and keep her-
self well through understanding and practising the fundamental
laws of health.
2. To show the close relationship of hygiene to all nursing
work, to emphasize the teaching function of the nurse, especially
in matters relating to hygiene, and to develop a rational and
scientific attitude toward the whole question of health pres-
ervation and disease prevention.
3. To teach a few general exercises which will help to
strengthen special muscles and keep the whole body in good
condition. To establish habits of regular outdoor exercise.
OUTLINE OP CLASSES
I. Introduction
Health and disease defined. Ancient and modern theories
about disease. Causes classified. Definitions of hygiene,
sanitation, public health, etc. Various ideals and conceptions
of health. Conditions governing individual health. Ethical
and economic aspects of hygiene. Importance of hygiene to
the nurse. Her educational function as an example and teacher
of hygiene.
II. Hygiene of Exercise
Muscular activity in relation to health. Kinds of exercise
and adaptation to age, sex, occupation, climate, etc. Meaning
of recreation. Value of sports and games. Fatigue, its symp-
toms and effects. Methods of rest and relaxation, mental and
physical. Importance of posture and right methods of stand-
ing, bending and walking.
III. Hygiene of the Skin
Structure and functions of the skin. Bathing. Kinds of
baths and effects of different temperatures. Care of the teeth,
hair, nails and hands. Soaps and toilet accessories — their
use and abuse. Prevention and treatment of common skin
infections and minor injuries.
64
PERSONAL HYGIENE 65
IV. Hygiene of Clothing
Function of clothing. Materials — cotton, silk, wool, linen,
etc., and their various uses. Adaptation of clothing to cli-
mate, age, occupation, etc. Hygienic clothing for the nurse
on and off duty. How to choose a good shoe. Special care of
the feet. Prevention and treatment of corns, bunions, ingrow-
ing toe-nails, and other foot troubles. Care of arch of foot.
Preventive exercises.
V. Hygiene of Respiration
Composition of normal air. Sources of impurities in the air.
Effect of temperature and moisture, still and moving air.
Principles of ventilation. Types of breathing. The use of the
voice — tone, pitch, quality, etc. Some principles of correct
speech and breathing.
VI. Hygiene of Nutrition,
Relation of food and food habits to efficiency. Energy re-
quirement of average nurse on active duty. Food fads, over-
eating, and under-eating. Conditions which interfere with
digestion and nutrition. Use of condiments, stimulants and
drugs. Water-drinking. Hygiene of elimination. Constipa-
tion— common causes and measures for relief.
VII. Hygiene of Special Senses
The causes and effects of common eye troubles. Conditions
for normal vision. Care and protection of the eyes especially
in hospital work. Need of expert examination and treatment
in eye defects. Common disorders of hearing — their causes
and effects. Protection and care of the ear. Causes and symp-
toms of common nose and throat troubles. Prevention and
care of colds and sore throats.
VIII. Hygiene of the Nervous System
Importance of nervous system to health of the whole body.
Ways in which mental influences affect the body. Conditions
in modern life which produce high nervous tension and fatigue.
Increase of nervous diseases and insanity. Importance of re-
laxation and sleep for conservation of nervous energy. Some
principles of mental hygiene for both nurse and patient.
IX. Hygiene of the Reproductive System
Function of menstruation and common disorders. Precau-
tions and ordinary measures to be observed. Problems of
social hygiene which confront the nurse. Necessity for a sane
and wholesome attitude of mind . . Effects of ignorance and
wrong teaching in the community at large. Ways in which
the nurse can help to promote racial and personal health and
happiness. Essentials of sex-hygiene.
X. Relation of Personal Hygiene to Community Health
Outstanding causes of ill-health in the community due largely
to individual ignorance and neglect. Standards of community
health as shown in death-rates. What constitutes a high and
66 OUTLINES OF SUBJECTS
low mortality rate for the general population — for infants.
Main causes of premature death and illness. Some movements
for the conservation of individual and public health by volun-
tary organization for prevention and care of tuberculosis, can-
cer, social diseases, diseases of infancy, diseases of middle age,
insanity, etc. How the nurse in the hospital and home may
help to educate the public.
METHODS OF TEACHING
1. Base hygienic rules on scientific principles, using courses
in anatomy and physiology and bacteriology as ground-work.
2. Stress the phases of the subject most needed by nurses,
and emphasize applications to nursing work.
3. Knowledge of hygiene is not of much use unless it is con-
sistently applied. Effort must be made to arouse stong in-
centives as a means of forming good hygienic habits. Some
teachers have pupils keep daily records for a time of baths,
exercise, sleep, etc., and report progress in habit-formation.
Often illness and slight indispositions, such as colds, etc., can
be traced back to personal lapses, and sentiment formed in
the school will aid greatly in maintaining good standards of
health.
4. Text books if used at all should be liberally supplemented
by outside readings from a variety of reference books, pam-
phlets, etc. Pupils in this way get a wider range of information
and a better knowledge of sources. They should be encouraged
to collect interesting cuttings from magazines, pamphlets, etc.,
and report on these in class.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Anatomical charts, skeleton, models, etc. Popular litera-
ture, posters, exhibit material. Lantern and slides. Gymna-
sium or room fitted up with simple apparatus, a distinct asset.
Also swimming pool.
TEXT AND REFERENCE BOOKS
Price: Hygiene and Sanitation for Nurses.
Hough and Scdgwick: Human Mechanism (Part II).
Pyle: Personal Hygiene.
Galbraith: Hygiene and Physical Culture for Women.
Latimer: Girl and Woman.
CFouston: Hygiene of the Mind.
Rosenau: Preventive Medicine.
Chapin: Sources and Modes of Infection.
Fisher and Fi.ske: How to Live.
Lee: Health and Disease.
Bancroft: Posture of School Children.
PUBLIC SANITATION 67
Lovett: Lateral Curvature of the Spine and Round Shoulders.
McKenzie: Exercise in Education and Medicine.
Pamphlets published by organizations dealing with prevention
of disease (see Appendix II.)
For Household Hygiene see under Hospital Housekeeping.
Public Sanitation
TIME: 10 hours. Lectures and quizzes conducted by physician with
Board of Health experience, or sanitarian, if possible. — Given
in senior year.
OBJECTS OP COURSE
1. To give the nurse a general, practical knowledge of the
methods which are being used to protect the health of individ-
uals and communities so she may cooperate actively with Boards
of Health and other preventive agencies, and be able to take
a definite share in educating the public in matters relating to
public health.
OUTLINE OP LECTURES
I. Introduction
History of sanitation, and older theories regarding the causes
of disease. Modern ideas as to sources and modes of infection.
Parasites and hosts. R6le of carriers, air, dust, discharges,
fomites, contact, food and drink, insects. Portals of entry and
exit in all commoner infections. Communicable diseases clas-
sified according to source of infection.
II. Sewage and Garbage Disposal
Danger from excreta. Composition of sewage. Methods of
disposal in large, small and rural communities. Dangers from
garbage. Composition and methods of disposal.
III. Water Supply and Ice
Sources of water supply. Dangers of polluted water — pro-
tection of water supply. Purification processes. Special prob-
lems of rural communities. Use of household filters. Sources
of ice supply. Dangers and methods of protection.
IV. Food Supply
Dangers of unclean or infected food supplies, especially meat,
shellfish, uncooked fruits and vegetables. Protection of food
supplies from dust and flies, from adulteration and misbrand-
ing. Pure food legislation. Special dangers from milk — ani-
mal diseases and human infection. Production of clean milk.
Dairy inspection. Bacteriological tests. Inspection of res-
taurants and lunch-counters. Medical examination of cooks,
waiters and others who handle food.
V. Air Supply and Ventilation
Normal air and its pollutions. Main dangers — excessive
heat with excessive humidity. Methods of air analysis. Effects
68 OUTLINES OF SUBJECTS
of dry air. Ventilation standards. Natural and artificial
methods of ^'entilation. Dangers in dust, largely mechanical.
Relation to tuberculosis. Methods of reducing dust in indus-
trial establishments.
VI. Housing and Extermination of Vermin
Effects of over-crowding. The tenement house problem.
Relation to tuberculosis, social diseases, and infant mortality.
Fundamental needs — fire protection, light, air, and cleanliness.
Remedial and preventive measures. Essentials of sanitary
inspection. Insects as carriers of disease. Household and
community measures for controlling vermin pests, flies, mos-
quitoes, etc.
VII. Industrial Hygiene
Brief history. Dangers of industry. Preventable accidents
on railroads, in mines and factories. Prevention of industrial
poisoning. Dangerous trades. Over-work and fatigue. Re-
medial agencies. Education, legislation, and inspection.
Work of Consumers League and other agencies. Welfare work
in factories from sanitary point of view.
VIII. Hygiene of Schools, Public Buildings and Conveyances
Importance of school hygiene in relation to community
health. Essentials of school hygiene as to construction, venti-
lation, light, seats, cleanliness, water-supply, toilet facilities,
fire protection, etc. Medical'inspection and school nursing in
relation to control of contagious diseases and identification
of physical defects. Hygiene of other public buildings such as
churches and theatres, of street cars and railways coaches (es-
pecially sleeping cars). Public toilets in relation to health.
IX. Vital Statistics.
Place of vital statistics in public health work. Neglect of
vital statistics in United States. Laws for registration of births
and deaths. Important points in the compilation and analysis
of statistics. Interpretation of statistical data. High and
low death rates for adults and infants. Mortality from im-
portant classes of disease compared.
X. Health Departments and Health Legislation
National, state, and local Boards of Health — province, powers
and organization of each. Function of bureaus of sanitation,
contagious diseases, laboratory service, vital statistics; pub-
licity, etc. General progress of health legislation. Rural
health organization. Publications of health departments.
METHODS OF TEACHING
1. The classes will usually be conducted by the lecture
method, supplemented by quizzes if possible.
2. Base the present course on previous knowledge of chem-
istry, bacteriology, and hygiene, and correlate closely with the
course in comrnunioablo diseases.
PUBLIC SANITATION 69
3. If possible, visits should be made to a sewage disposal
plant, a model dairy, an industrial plant, and other local places
of interest, to get a clear and vivid conception of conditions
and methods. Otherwise photographs, diagrams, and models
could be shown. Several good moving-picture screens on sani-
tary subjects are in circulation and should be seen. Excellent
exhibits are on view in the Natural History Museum in New
York City and in similar institutions in other cities. The
National Public Health Service and several state and local
Health Boards have loan collections of lantern sides which
can be borrowed for a time for educational work.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Lantern slides, models, charts, maps, etc. A collection of
pamphlets and reports from Boards of Health and voluntary
orgznizations are very helpful and can be secured free of cost.
(See lists Appendix II and III.)
TEXT AND REFERENCE BOOKS
Price: Hygiene for Nurses.
Rosenau: Preventive Medicine and Hygiene.
Baskerville: Municipal Chemistry.
Chapin: Sources and Modes of Infection.
Kinnicutt and Winslow: Sewage Disposal.
Kober: Industrial and Personal Hygiene.
Oliver: Diseases of Occupation.
Sedgwick: Principles of Sanitary Science and Public Health.
Doane: Insects and Disease.
Hill: The New Public Health.
Broadhurst: Home and Community Hygiene.
Veiller: Housing Reforms.
American Journal of Public Health.
Local and State Board of Health Bulletins.
Public Health Service Bulletins.
See also under Bacteriology, Hygiene, and Communicable
Diseases.
D. TREATMENT OF DISEASE
Drugs and Solutions
TIME: 20 hours or ten two-hour periods divided about equally between
class and laboratory work. Teacher — the instructor of nurses
(preferably) or the pharmacist.
To be given in the Preliminary Course.
OBJECTS OF THE COURSE
1. To make the nurse familiar with the appearance and use
of the commoner drugs which she will be handling in the earlier
part of her course.
2. To teach her to weigh and measure drugs accurately, to
make up all the standard solutions, and the commoner phar-
maceutical preparations used in the wards. .
3. To teach her the terms and symbols used in materia medica
and prepare her for the further study of the therapeutic action
of drugs.
OUTLINE OF CLASSES AXD LABORATORY WORK
I. (Class) Introduction — Weights, Measures, Symbols, etc.
Review of simple arithmetical problems. Roman and arabic
numerals. English system of weights and measures. Symbols,
abbreviations. Drops and minims.
(Laboratory) Practice in use of apothecaries' weights and
measures. Drill in the tables. Problems, oral and written.
II. (Class) Weights and Measures (continued)
Metric system. Approximates in apothecaries and house-
hold measures.
(Laboratory) Practice in use of metric system. Drill and
problems in approximates.
III. (Class) Solutions.
Definition of solute, solvent, and examples. Saturated and
supersaturated solutions. Solutions of solids, liquids and
gases (examples). Fahrenheit and Centigrade scales. Method
of expressing strength, ratio and percentage. Method of
calculating solutions from pure drug.
(Laboratory) Make physiological salt solution. Problems
and drill in converting ratio to per cent and vice versa. Prob-
lems in calculating the amount of drug for solutions of different
strength.
IV and V. (Class) Disinfectants, Antiseptic, Deodorants
Physical properties, therapeutic uses, method of bactericidal
action, care in handling, and toxicology of common solutions,
such as phenol, bichloride, boric, iodine, crcolin, lysol, formalin.
(Laboratory) Practice in making these solutions. Problems
and drill in calculations.
70
DRUGS AND SOLUTIONS 71
VI. (Class) Symbols and Abbreviations
Orders and abbreviations used in order book. Prescriptions,
form, abbreviations. Method of making weak from strong
solutions.
(Laboratory) Practice in making solutions from stock.
Problems in calculations . Practice in reading prescriptions.
VII. (Class) Dosage
Method of calculating doses for children. Method of cal-
culating fractional doses. Method of measuring minims and
half drop.
(Laboratory) Review of solutions. Practice in measuring
fractional doses and in calculating children's doses.
VIII. (Class) Common Pharmaceutical Preparations
Sources of drugs. Crude drugs, Methods of preparing
tinctures, extracts, emulsions, etc. Method of application of
local remedies such as ointments, salves, liniments, supposi-
tories.
(Laboratory) Visit to pharmacy. Some of preparations
made by students or demonstrated.
IX. (2-hour class and quiz) Action of Drugs on the Body
Meaning of terms such as local, systemic, cumulative, ra-
tional, empiric, physiological and therapeutic, with examples.
Methods of administration, absorption and excretion of drugs.
Forms suitable for each method of administration. Names and
meanings of common classes of drugs such as analgesics, ano-
dynes, diuretics, and common examples.
X. (2-hour class and quiz) Introduction to a Few Specially Im-
portant Drugs
Common potent drugs' — strychnine, caffeine, atropine, and
morphine. Use, forms commonly used, early symptoms of
over-dosage, treatment of poisoning. Common cathartics,
emetics and carminatives. Action and method of administra-
tion. Dangers in the use of habit-forming drugs. The patent
medicine evil, and the menace of self-drugging. Use and abuse
of drugs.
METHODS OF TEACHING
1. Class periods should be conducted by the question and
answer method, with full discussion of all the new drugs which
have come under the pupil's observation.
2. Laboratory periods should be held in a specially fitted
up class-room or in the hospital pharmacy. Pupils should
make up solutions and should have extra experience in the
pharmacy, if possible, in the making up of stock preparations
of various kinds.
3. A great deal of drill will be needed in the making-up of
solutions and solving of solution problems. Many of these
arithmetical problems may be worked out outside of class and
72 OUTLINES OF SUBJECTS
handed in. Many teachers find it necessary to give a pre-
liminary drill of two or three lessons in fractions, decimals,
proportion and percentage.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Drugs in different forms. Samples of crude drugs and grow-
ing plants when possible. Charts for metric and English system
and all the different kinds of measures' — pitchers, measures,
funnels, etc. (a set for each pupil in the laboratory section) and
stock bottles of all the common drugs for making up solutions.
TEXT AND REFERENCE BOOKS
Dock: Materia Medica for Nurses.
Parker: Materia Medica.
Stimson: Nurses' Handbook of Drugs and Solutions.
Bastedo: Materia Medica and Therapeutics.
Sollmann: Text Book of Pharmacology.
New and Non-Official Drugs — (published yearly by the Ameri-
can Medical Association).
Stevens: Modern Materia Medica and Therapeutics.
Blumgarten: Materia Medica for Nurses.
Foote: Essentials of Materia Medica and Therapeutics for
Nurses
Materia Medica and Therapeutics
TIME: 20 one-hour periods. To be given in the second half of the first
year, preferably by a physician.
OBJECTS OF COURSE
1. To continue the study of drugs from the standpoint of
their therapeutic action, emphasizing the accurate and intelli-
gent administration of medicines, and the observation and
reporting of results.
2. To teach pupil nurses enough about the nature and thera-
peutic action of drugs, so that they may understand the general
purposes for which different drugs are ordered, may cooperate
intelligently with the physician in his effort to get the best
results from the drug, and may appreciate the importance of
observing the after-effects, particularly watching for any
dangerous or untoward effects from drugs.
3. They should also be familiar with the toxic doses of all the
more dangerous drugs, so that they may better safeguard the
patients from possible errors. Every nurse should know the
antidotes for all common forms of poisoning and should be
ready to render first aid in such cases.
OUTLINE OF CLASSES
I. Applications of Chemistry to Materia Medica. Active princi-
ples of plants — alkaloids, glucosides, oils, etc. Chemical and
MATEKIA MEDICA AND THERAPEUTICS 73
physical properties, therapeutic action and use, source and
examples. Action and common uses of acids, alkalies and
medicinal salts.
II. Poisons and Antidotes
Studied in groups — acids, metallic salts, alkaloids, etc., with
general principles for the treatment of poisoning by each type.
Demonstration or practice in preparation of general antidotes.
Ill, IV, V, VI. Drugs which Act on the Nervous System
Central stimulants. Central depressants. Hypnotics. Gen-
eral anesthetics. Local anesthetics. Analgesics. Anodynes.
Mydriatics. Myotics.
VII, VIII, IX. Drugs which Act on the Circulatory System
Tonics. Stimulants. Depressants. Vasodilators. Vaso-
constrictors. Hematinics.
X, XI. Drugs which Act on the Respiratory System
Stimulants. Sedatives. Antiseptics. Expectorants.
XII. Drugs which Act on the Digestive System
Emetics. Antiemetics. Digestants. Stomachics. Intestinal
Antiseptics. Carminatives. Cathartics. Antidiarrheics.
Anthelmintics.
XIV, XV. Drugs which Act on the Excretory System.
Diaphoretics. Anhidrotics. Urinary antiseptics. Diuretics.
XVI, XVII. Drugs which Act on Skin and Mucous Membranes
Counter-irritants. Disinfectants. Astringents. Styptics.
XVIII, XIX. XX. Specifics and Miscellaneous Drugs
Phosphorus. Iodides. Antipyretics. Specifics. Quinine.
Mercury. Salvarsan. Salicylates.
1. Same general principles as outlined under Drugs and
Solutions.
2. Every opportunity should be taken to tie up the class work
with the ward work. Pupils should be asked to report on the
action of drugs being used on their wards. The teacher should
visit the wards and quiz the pupils on the medicines which are
being given to different patients and the effects they have
observed. Any unusual action of drugs, such as a drug rash,
or any case where a rare or new drug is being used, should be
brought to the attention of the whole class in the form of a
clinic.
3. Frequent short tests, both oral and written, should be
given. The analysis of prescriptions to determine the amount
of any given drug being given in one dose or in 24 hours, is
often helpful.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Same as under Drugs and Solutions — also bedside charts.
74 OUTLINES OF SUBJECTS
TEXT AND REFERENCE BOOKS
See under Drugs and Solutions. — Also
Hare: Practical Therapeutics.
Brunton: Lectures on the Action of Medicines.
Stainsbury: Drugs and the Drug Habit.
Nostrums and Quackery (Published by the American Medical
Association).
See also under subjects like Medical Nursing, Surgical Nursing,
Obstetrical Nursing, etc.
Massage
TIME: 10 hours divided as follows: —
Classes and Demonstrations — 5 hours.
Practice periods — each group 5 hours.
Teacher an expert masseuse preferably a trained nurse.
Given as early as possible in the training — not later than the
early part of the second year.
OBJECTS OF THE COURSE
1. To teach the nurse to do ably, intelligently and with ease
(without awkwardness and wasted energy) such rubbing as is
necessarily a part of her duties as a nurse; and to enlarge this
field somewhat. (The nurse is not trained however, to be a
specialist in massage.)
2. To develop a good touch, and a fair degree of manual
. dexterity in both hands.
3. To give the nurse an intelligent conception of the full
scope of massage as a therapeutic measure, and to fit her to
justly appraise the work of a masseuse employed for a patient
in her charge.
OUTLINE OF CLASSES AXD PRACTICE PERIODS
I. (Class) Introduction
Object of instruction in massage and growing importance of
this form of treatment. History of massage. Definitions and
nomenclature. Fundamental manipulations common to all
systems of massage analyzed and demonstrated. Review of
anatomical land-marks and essential points in anatomy of
muscles, blood vessels and nerves.
II. (Practice) Class practice of simplest examples of the funda-
mental manipulations with special reference to the stroking
movements.
III. (Class) General Massage
The physiological effects of massage — therapeutic uses and
centra-indications to use. General massage defined and pro-
cedure outlined. Preparation of patient and care during and
after treatment.
IV. (Practice) General Massage
MASSAGE 75
V and VII. (Class) Local Massage
Conditions in which local massage is used. Effects to be
produced. Procedure in various conditions. Precautions to
be observed in abdominal massage, massage of spine, joints,
breast, etc.
VI and VIII. (Practice) Application of local massage in above conditions.
IX. (Class) Medical Gymnastics
Various systems of medical gymnastics. Active and passive
movements. Conditions in which used and resulting effects.
X. (Practice) Assistive and resistive movements — circumduction,
rotation, flexion, etc.
METHODS OF TEACHING
1. Classes and demonstrations may be given to fairly large
groups, but for practice work, class must be divided into sec-
tions of not more than 8 to 10 pupils. For small groups the
class and practice may be combined in one period.
2. It is absolutely essential that pupils should have plenty
of practice to gain facility in the use of the hand. Convales-
cent patients may serve as subjects or pupils may practice on
each other. The latter method is preferred.
3. Questions and criticisms by the teacher serve to bring out
important points, Written questions may be assigned for
students to look up and answer. Both written and practical
tests should be required at the end of the course.
4. Selected text and reference books should be used, and if
necessary the teacher may supply abridged notes of the essen-
tial points and procedures covered, to economize the pupil's
time and secure accuracy.
5. Every opportunity should be given for the practice of
these procedures on the wards.
EQUIPMENT AND ILLUSTRATIVE MATERIAL.
Beds and ordinary bedding with extra light-weight treatment
blankets, chest-blankets, towels, sheets, (small) pillows, (small)
knee pillows, hot-water bag, lubricant and talcum powder.
Four beds should be provided for a class of eight.
TEXT AND REFERENCE BOOKS
Mitchell and Gulick: Mechano Therapy and Physical Educa-
tion.
Palmer: Lessons on Massage.
Despard: Text-Book of Massage.
Cyriax: Kellgren's Manual Treatment.
McKenzie : Exercise in Education and Medicine.
Graham: Massage.
76 OUTLINES OF SUBJECTS
Special Therapeutics (Including Occupation Therapy)
TIME: 10 hours — in lectures, class and demonstration, by instructors who
are specialists in the various branches discussed.
Given in the Senior Year.
OBJECTS OF COURSE
1. To give the nurse a good general idea of the principles
underlying the newer methods of treatment which are to a con-
siderable extent replacing the treatment by drugs.
2. No attempt is made here to specialize in any of these
forms of treatment, but only to enable the nurse to cooperate
intelligently with those who prescribe and administer them
and to show the possibilites of specialization which are open
to nurses.
OUTLINE OF CLASSES
I. Hydrotherapy
History and modern development of treatment by water.
Effects of temperature and pressure on skin and nervous sys-
tem. Indications and contra-indications for treatment. Com-
bination of hydrotherapy with special climatic conditions.
Influence of altitude, temperature and moisture in air. Com-
parative value of mountain, sea-side and mineral springs for
various heart, kidney, lung and nervous conditions.
II. Practical Procedures in Hydrotherapy
(Demonstration) Salt-rubs — mineral baths — needle baths —
sprays and douches — packs, tubs and ablutions — local and
general.
III. Mechanotherapy
Newer forms of manual and mechanical treatments. Indica-
tions and contraindications for treatment. Physical exercises.
Active games. Exercising apparatus. Equipment, varieties
and value. Substitutes where a gymnasium is not available.
IV. Treatment by Light-Rays and Electricity
X-Ray — Radium — Finsen Light — Heliotherapy — Electrother-
apy. The therapeutic action of these agents. Special indi-
cations and contraindications for treatment, precautions and
after care of patients.
V. Serum-Therapy
Theories underlying the use of serums reviewed. Prepara-
tion of various sera. Methods of administration. Observation
of patient. Prophylaxis and anaphylaxis. (Visit to a research
laboratory, if possible.)
VI. Occupation Therapy
History of the development of work cures. Conditions in
which occupation is particularly indicated as a therapeutic
agent. Mental and physical effects of occupation. Psycho-
SPECIAL THERAPEUTICS 77
logical and physiological processes involved. Economic and
moral aspects of occupation therapy.
VII and VIII. Choice of Occupations
Factors to be considered in choice of occupations for patients
— physical condition, nature of the disease or handicap, dura-
tion of the disease, mental and manual equipment, age, previ-
ous life, personal tastes and capacities, disposition, etc. Main
types of patients to be considered. Types of occupations
suitable for sick and handicapped — therapeutic value of each
— suitability and practicability for various types of cases —
mental and nervous, tubercular, heart cases, etc. Sedentary
work — embroidery, basketry, chair-caning, modeling, paper-
work, string work, etc. Active indoor occupations — shop-
work, cement, loom-weaving, etc. Outdoor work — gardening,
farming, photography, etc. Recreations — entertainments, dra-
matic games, dancing, music, reading, etc.
IX. Equipment and Materials
Requirements in tools, materials, etc., needed for commoner
types of occupations. Practical possiblities for the general
hospital patient, for sanatoria, private cases and district work,
etc. Prices and purchasing of reed, wood, paper, etc. The
use of waste materials — rags, paper, string, etc. Disposal of
products.
X. Methods of Teaching Occupations
The problems of bedside teaching and class-teaching. How
to secure interest and cooperation. Need of careful planning
and preparation. Importance of variety. Dangers of over-
doing. Cultivation of originality and initiative. Develop-
ment of the artistic sense. Value of appreciation and com-
mendation as incentives. Encouragement of social motives
as opposed to commercial or individualistic. Concrete prob-
lems provided. Helping real people. Perfection in workman-
ship comparatively unimportant. Educational and therapeu-
tic results primary objectives.
(NOTE). If additional time can be given and a teacher of
occupations can be secured, these classes should be supple-
mented by at least 10 to 20 hours in hand-work. A selection
might be made from the following:
Sewing and fancy work — Knitting, crocheting, tatting,
embroidery, rug-making, rake-knitting, etc.
Basketry and weaving, using raffia, reed, and other mate-
rials.
String-work — knotting and hammock-making.
Wood-work — carving and simple construction in wood.
Paper-work — simple book-binding, papier mache work.
Leather work.
78 OUTLINES OF SUBJECTS
METHODS OF TEACHING
1. Lecture and class work should be supplemented by demon-
stration as far as possible. If more time is available, students
should also carry out the main procedures in class to be sure
that they have a grasp of the principles of technic, otherwise
practice should be provided in connection with the nurse's
general work. Class visits to X-ray rooms, hydrotherapeutic
departments, etc., should be made to show the equipment in
operation.
2. In the occupational classes samples of the patient's work,
poor as well as good, should be exhibited with brief histories
of the cases, showing how handicaps are overcome and therapeu-
tic results accomplished. Nurses should be encouraged to make
themselves skillful in as many forms of occupational work as
they can. Patients should be observed at work, and case
records and charts studied to trace the relation between oc-
cupation prescribed and the patient's condition.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
Samples of work, pictures of work-rooms, of handicapped
individuals at work, and finished products. X-ray plates,
charts, apparatus, etc., to illustrate subjects under discussion.
TEXT AND REFERENCE BOOKS
Dunton: Reconstruction Therapy.
Hare: Practical Therapeutics.
Kellogg: Rational Hydrotherapy.
Baruch: Principles and Practice of Hydrotherapy.
Hinsdale: Hydrotherapy.
Potts: Electricity in Medicine and Surgery.
Tracy: Invalid Occupations
Tracy: Rake-Knitting.
Dunton: Occupation Therapy.
Hall and Buck: The Work of Our Hands.
See also under Nursing in Mental and Nervous Diseases,
Materia Medica and Therapeutics^ etc.
For Dietary Treatment see under Diet in Disease p. 22.
E. NURSING IN DIFFERENT FORMS OF DISEASE
Elementary Nursing Principles and Methods
TIME : 60 hours, 30 lessons of 2 hours each divided about equally between
theory and practice. To be given in the preparatory course.
Teacher — the nurse instructor.
OBJECTS OF COURSE
1. To give a clear understanding of the fundamental princi-
ples which underlie all good nursing, to develop habits of ob-
servation, system, economy, and manual dexterity and to
establish a uniform an.d finished technic.
2. To prepare pupils to meet the problems that will confront
them in their daily work, limiting their duties as far as possible
to those which they can understand and safely practice in the
earlier stage of their training.
3. To test out the aptitude of pupils, with a view to selecting
those who are fitted to continue the work.
OUTLINE OF CLASSES
I. Introduction. How to Provide the Best Kind of Accommodation
for Sick People.
Purpose of the hospital and kinds. Importance of the nurs-
ing service. What such service includes. Survey of general
plan of the hospital. Different departments and their relation
to one another. Plan of work to secure efficient service.
(Class to be taken on a trip round the hospital.)
II. The Patients' Surroundings. How to Make Them Clean, Com-
fortable and Attractive.
Effect of environment on sick people. The plan of the ward
and private rooms, furnishings, arrangement, temperature,
ventilation, light, cleaning and care. (If the course in hospital
housekeeping can not be given, a longer time will have to be
given to this lesson and the following.)
III. Lavatories and Service Rooms. How to Keep Them in Good
Condition.
Relation of these to welfare of patient and work of the
staff. Equipment and arrangement of lavatories, linen-rooms,
utility rooms, etc. Care and cleaning of rooms, utensils and
appliances.
IV and V. Getting a Bed Ready for a Sick Patient
Possible conditions to be met in person to occupy bed. Kind
of bed and bedding needed in hospitals for comfort, safety,
economy, sanitation, etc. Cleaning, disinfection and care of
beds and bedding. How to make closed and open bed and
children's cot.
79
80 OUTLINES OP SUBJECTS
VI. How the Hospital Admits its Patients and Cares for Their
Property
Types of patients and how they come to the hospital. What
can be done to make them feel at home and save them from fear
and worry. Routine in admitting-room, office and ward.
Clothing to be provided. Helping with tub bath and getting
patient to bed. Listing and caring for clothing and valuables.
Precautions regarding vermin. What the social service de-
partment does for special cases.
VII and VIII. How to Care for the Patient's Immediate Physical Needs and
Make Him Comfortable in Bed
Sources of discomfort and how to alleviate them. Positions
of patients in bed. Devices for comfort — pillows, pads, rings,
etc. Giving bed-pan. Lifting and turning. Dressing and
undressing. Changing bed with patient in it. Changing
mattress with patient in bed.
IX . Moving and Carrying Sick and Helpless Patients
Condition of patients to be specially considered. Impor-
tant points in handling and carrying patients. Assisting in
walking. Carrying with and without a stretcher. Putting
the patient up on a back-rest. Getting patient out of doors
in a chair. Making bed for balcony patient. Restraint for
irresponsible patients. How and when to restrain.
X and XI. Bathing the Patient
Purpose of the bath and method of giving bed-bath and night
toilet. Care of mouth and teeth. Care of nails and hands.
Brushing and combing hair. Precautions and treatment for
pediculi. Washing the hair in bed. Care of nurse's basket
or tray.
XII. Prevention and Treatment of Bed Sores. Relief of Common Dis-
comforts
Causes of skin irritations. Prevention and care of bed-sores.
Other causes of restlessness and sleeplessness. How to secure
relaxation. Regulation and treatment of visitors. General
handling of nervous patients. Hot-water-bags and cold com-
presses, etc. as aids to comfort. Alcohol rub and simple rub-
bing movements.
XIII. How to Nourish the Patient
Importance of food in restoring health. Physiological and
psychological factors in relation to appetite. The serving of
food to different types of sick and helpless persons. Care of
food in kitchen and ward. Care of convalescent table.
XIV, XV and XVI. What to Observe and Record About a Sick Patient's
Condition
Importance of accurate and careful observation. How to
observe. Cardinal nymptoins — temperature, pulse, respiration,
and other important indications of patient's condition. Col-
ELEMENTARY NURSING 81
lection and care of specimens. Purpose of charts. Methods
of charting. (Extra practice in printing to be given.)
XVII. Assistance in Examination of the Patient
Purpose of examination and common procedure followed.
What the doctor needs for various types of examinations.
Positions and assistance. How to protect the patient. Prep-
aration for blood counts, Widals, etc. How to take the doc-
tor's orders.
XVIII. Administration of Common Medications
Special precautions in handling of medicines. Care of medi-
cine tray and hypo tray. Care of medicine cupboard and ap-
paratus. Administration of medicines by mouth. The ticket
and other systems for ensuring accuracy.
XIX. Nursing Measures in Common Digestive or Intestinal Disturb-
ances
Causes and treatments usually given for nausea, vomiting,
flatulence, colic, etc. How to give a simple enema. How to
irrigate the bowel in a child.
XX. Nursing Measures in Simple Infectious Conditions
Infectious nature of colds, coughs, sore throats, etc. Pre-
cautions in care of excreta, linen, dishes, etc. How to give
sprays, irrigations, gargles and inhalations. How to prepare
a croup-tent. How to give oxygen. Care of room and belong-
ings after an infectious case.
XXI, XXII, XXIII. Local Applications for Inflammation and Congestion
Condition of circulation in inflammation. Action of heat
and cold. Application of hot-water-bags, electric pad, poul-
tices, fomentations, compresses, ice-bags, ice-coils, etc., to
different parts. Action of counter-irritants and application
of mustard paste. The foot bath, sitz bath, and mustard bath.
XXIV. The General Care of Chronic and Convalescent Patients
Position and care in chronic heart-troubles, asthma, ascites,
paralysis, etc. Care of rheumatics. Baking for stiff joints.
Wrapping joints. Application of liniments. Simpler move-
ments of massage. Filling and care of air and water beds.
Care of convalescents.
XXV. The General Care of Sick Children in the Hospital
Special problems to be met with children. Methods of
lifting, carrying, bathing, dressing and feeding. Common
conditions and treatments in children's ward. The daily rou-
tine. Entertaining and managing sick children.
XXVI and XXVII. Elementary Nursing Measures in Surgical and Ortho-
pedic Conditions
General principles in surgical work. Cleaning and steriliza-
tion of instruments. Clearing trays, care of splints, sand-bags,
extensions, etc. Making of surgical bed and ether bed. Care
of patient in Bradford frame. Arm and foot baths for surgical
conditions.
82 OUTLINES OF SUBJECTS
XXVIII. Elementary Nrirsing Measures in Gynecological Conditions
Nature of conditions to be dealt with. Positions and mate-
rials for examinations and treatments. Douches. Prepara-
tion and clearing away of catheterization trays. Venereal
precautions.
XXIX. Elementary Measures in Eye, Ear and Skin Cases
Nature of conditions to be cared for. Eye-bathing, com-
presses and drops. Removal of foreign bodies in eye. Prep-
aration of trays for eye and ear treatments. Application of
ointments and lotions for common skin troubles. Eczema
masks. Care of infectious skin conditions.
XXX. Special Problems
How the hospital discharges its patients. Getting the pa-
tient ready to go home. Routine of discharge. Assistance by
social service department in special cases. What to do in case
of approaching death. The care of the body. Disposal of
clothing, valuables, etc. Care of delirious patients. Night
care of sick patients.
NOTE. It is very desirable that some additional time should
be given in connection with this course for a brief discussion
of occupations and diversions for ward patients. Pupils can
teach each other many of these processes, and if their interest
is once aroused they will begin at once to devise and learn
new ways of employing their patients' idle hands and minds.
Some practical application of the simpler games and common
forms of hand-work could be made in the daily work in the
wards and dispensary. The special therapeutic effects of occu-
pation would not be discussed here. The main points to be
covered are as follows:
1. How to occupy the patient's mind. The mental and
physical effects of idleness both on well and sick people — the
special need for diversion and occupation in certain types of
disease, as an antidote to worry and a source of interest and
mental stimulation. Use of books and pictures in the hospital.
Choice of stories and anecdotes for different ages and types of
patients, bed games, cards, puzzle-pictures, floor and table
games, checkers, chess, dominoes, block-building, etc. The
storing and care of materials in the wards. The use of waste
materials.
2. Suggested occupations for special types of patients in the
hospital. Hand-work, entertainment and diversions, suited to
children, women, men, and patients with special handicaps.
(For equipment, reference-books, etc., see under Special
Therapeutics.)
METHOD OF TEACHING
1 . In order to insure complete understanding of the principles
involved, about half the time will usually be required to ques-
ELEMENTARY NURSING 83
tion the students and explain the purpose of the various treat-
ments, the conditions in which each is used, the effects to be
looked for and the precautions required. The demonstration
should follow or accompany this part of the lesson, and might
be given to the whole class unless it is very large.
2. For practice work, the class should be divided into sections
of from eight to twelve pupils, depending on the amount of
equipment available. For all the commoner procedures each
pupil should have an individual set of appliances as in the diet
kitchen, but if this is not possible pupils can work in groups of
two or three. The teacher supervises the practice work, quiz-
zing the pupils and explaining where necessary. Pupils may
be asked to criticize each other's work, and sometimes to dem-
onstrate for the group. Frequent reviews are desirable, and
a final demonstration before the superintendent and head nurses
is often found to stimulate careful and finished work.
3. If the pupils are regularly assigned to ward duty, much of
the practice or drill can be carried on in the wards under the
general supervision of the instructor. If the student is not on
ward duty, extra hours will have to be allowed for practice work
in the demonstration room till skill and confidence are de-
veloped. Pupils should not be allowed to perform any duties
in the wards till the method has been thoroughly taught in the
demonstration room. This method should be the one in use
throughout the hospital.
4. To secure uniformity in method, it is well to have a type-
written or printed book of standardized procedures for reference
in each ward. These methods should be carefully worked out
to secure the greatest safety, comfort, and best therapeutic
results for the patient, and the greatest economy in time,
effort and materials for the staff and the hospital. Neatness
and simplicity of procedure are also of primary importance.
5. It is desirable that the nursing procedures taught in the
probationary period should include only the simpler and less
technical treatments, those which do not demand fine skill or
much experience and understanding of disease, and those which
would not likely be misused if the pupil is not retained in the
hospital. If it is absolutely necessary for pupils to be given
more responsible work such as night duty immediately follow-
ing the preparatory course, certain other procedures may have
to be taken up in this elementary course, such as catherization,
hot and cold packs, intestinal irrigation, nutrient enema, etc.
It is advisable however to defer these till the pupil has had
more experience and knowledge and till she has properly mas-
tered the fundamentals as outlined above. Courses in medical
and surgical nursing should follow this elementary course.
84 OUTLINES OF SUBJECTS
EQUIPMENT AND ILLUSTRATIVE MATERIAL
1. A special demonstration room or laboratory should be
fitted up for the teaching of practical nursing. This should be
large enough to allow eight to twelve students to work freely
at one time. It should have ample cupboard and drawer space
for supplies, and several good-sized tables, as well as black-
boards, chairs, etc.
2. The demonstration room should contain a complete equip-
ment of the materials needed for class work — beds, linen,
enamel and glass-ware, drugs and supplies. For all the com-
moner procedures each pupil or pair of pupils should have an
individual set if possible. Expensive or cumbersome articles
can be borrowed from the wards, when needed. Sometimes it
is possible to use an empty ward or a good-sized private room
as a practice room and then ward supplies and equipment may
be used.
3. Demonstration dolls or manikins can be used for many
demonstrations, though the living subject is better if one can
be secured. Pupils can be used as subjects in many procedures.
A home-made life-size doll can be made quite inexpensively,
covered with single-faced rubber so that it can be bathed and
tubbed if desirable.
4. Anatomical charts and models, the skeleton, and other
illustrative material will be needed.
(For plan and equipment of demonstration room see articles
in 1914 and 1915 Reports of National League of Nursing
Education, also The Modern Hospital, June, 1918.)
TEXT AND REFERENCE BOOKS
Nightingale: Notes on Nursing.
Maxwell and Pope: Practical Nursing.
Sanders: Modern Methods in Nursing.
Robb: Nursing — Principles and Practice.
Mclsaac: Primary Nursing Technique.
Brown: The Junior Nurse.
Bridge: Nursing Manual.
Wheeler: Nursing Technic.
See also books on Anatomy and Physiology, Bacteriology,
Chemistry, Physics, Hygiene, and Medical and Surgical Nurs-
ing.
Elementary Bandaging
TIME: 10 hours. Class, demonstration and practice in two-hour periods.
Taught by the instructor of nurses or a competent head-nurse.
Given in the preparatory course. (May be combined with
course in practical nursing).
ELEMENTARY BANDAGING 85
OBJECTS OF THE COURSE
1. To teach the fundamental principles of good bandaging
as a basis for all future practice in connection with surgical
and orthopedic work, first aid, etc.
2. To develop a fair degree of manual dexterity and skill
in the application of the commoner and simpler bandages.
OUTLINE OF CLASSES
I. Introduction
Purposes for which bandages are used. Variations in mate-
rials, width, length, etc., of roller bandages. How to make
and roll bandages. Triangular, cravat, four-tailed, and sculte-
tus bandages. Their uses and common applications. Slings
of different types and their application. Knots.
II. The Circular and Spiral Bandage, and the Spica (Hand and Arm)
Methods of holding, starting and ending the roller bandage.
Circular bandage of the wrist, spiral of the arm and finger,
spica of the thumb, complete gauntlet of the hand and demi-
gauntlet.
III. The Spiral Reverse and Figure-of-Eight of the Arm
Purpose and technic of the reverse. Spiral reverse of the arm,
figure-of-eight of the arm and elbow (including the hand),
spica of the shoulder.
IV. Spiral Reverse and Figure-of-Eight of Leg and Foot
Spiral reverse of leg. Spica of the foot (covering the heel).
Figure-of-eight of the ankle. Figure-of-eight of the leg. Spica
of the groin.
V. Special Bandages of the Head and Chest
Figure-of-eight of the shoulders and chest. Suspensory of
the breast (single and double). Recurrent head-bandage.
Oblique of the jaw. Barton's bandage and eye-bandage.
METHODS OF TEACHING
1. The class period should be devoted largely to demonstra-
tion and practice, with criticism by the teacher. When the
pupil has caught the right idea, the necessary extra practice
to acquire speed and dexterity can be done outside the class-
room.
2. Pupils may practice on each other where this does not
necessitate a great waste of time for the model. It is better to
have the human model to practice on, but fairly satisfactory
work can be done on wooden or plaster-of-paris models (see
below) or on the doll until the method is acquired.
3. Books or charts with good illustrations of bandaging
technic should be used freely by the pupils to supplement
demonstrations by the teacher.
86 OUTLINES OF SUBJECTS
EQUIPMENT AND ILLUSTRATIVE MATERIAL
1. Bandages of all varieties should be available for demon-
stration and for use by pupils.
2. Models of head, arm, leg, hand, etc., may be secured and
mounted in convenient positions for practice.
3. Improvised models may be made by pouring plaster-of-
paris into a firm glove or stocking and moulding quickly to
the shape desired. Plaster-of-paris models of heads may also
be made at small cost.
TEXT AND REFERENCE BOOKS
Eliason: Practical Bandaging.
Davis: Principles and Practice of Bandaging.
Hopkins: The Roller Bandage.
Wharton: Minor Surgery and Bandaging.
Morrow: Immediate Care of the Injured.
See also under Surgical and Orthopedic Nursing.
Elements of Pathology
TIME : 10 hours. Lecture, class and laboratory work, conducted by pathol-
ogist with assistance of instructor if necessary. Second term
of first year.
OBJECTS OF COURSE
It is not the intention here to make the nurse technically
skillful in performing laboratory tests, but rather to help her
to understand the principal causes that lead to disease, the na-
ture of some of the commoner disease processes, the meaning of
terms used in describing pathological conditions, and the
importance of the various diagnostic measures especially as they
touch her work. If she understands these things she will boa
better observer of symptoms, more intelligent in applying treat-
ments, and will be able to cooperate intelligently with the phy-
sician and the pathologist in such tests and experiments as they
wish to carry out on the wards.
OUTLINE OF CLASSES AND DEMONSTRATIONS
I. General Features of Diseases
Brief review of history of pathology. Classification of dis-
eases according to effect on the body (functional and organic),
origin (constitutional and environmental) and nature of disease.
Causes classified into predisposing (heredity, environment,
climate, age, sex, occupation, etc.) and direct or exciting (me-
chanical, physical, chemical, and parasitic) . Examples of each.
Meaning of immunity, susceptibility, predisposition, and idio-
syncrasy. Role of bacteria and animal parasites reviewed.
Effects of bacteria on the tissues.
ELEMENTS OF PATHOLOGY 87
II and III. Disease Processes or Conditions
Congenital (malformations, weaknesses, defects, etc.). Dis-
orders of digestion and metabolism (faulty digestion, elimina-
tion or secretion). Disturbances of circulation (heart lesions,
congestion, haemorrhage, thrombosis, oedema, etc.). Retro-
grade processes (atrophy, degeneration, necrosis, gangrene,
death). Progressive processes (hypertrophy). Inflammation
• — symptoms, causes, processes (hyperemia, exudation, diape-
desis, resolution, suppuration, ulcer, abscess, sinus, etc.). Proc-
esses of tissue rapair. Results of reparative processes.
IV. New Growths
Tumors — cause, structure, nature (benign and malignant),
dangers, varieties (lipoma, fibroma, dermoid cyst, sarcoma,
carcinoma). Tumor-like growths (gummata in syphilis, tuber-
cles in tuberculosis, and nodules in leprosy), cavities (tubercu-
losis and dental caries). False membranes, strictures and
adhesions.
V and VI. Observation of Symptoms (Aids to Clinical Diagnosis)
Importance of correct observation and accurate description
of symptoms' — objective and subjective. Important symptoms
relating to central nervous system, special senses, respiratory
tract, alimentary tract, vascular system, organs of elimination,
muscular system, bony system, reproductive system, and duct-
less glands. Purpose and care of the stethoscope, sphygmo-
manometer, and other apparatus used in clinical diagnosis.
VII. Methods of Laboratory Diagnosis
Methods of obtaining and preserving specimens for examina-
tion. General purpose and significance of tests made in patho-
logical laboratory (blood, dropsical fluid, spinal fluid, pus,
sputum, vomitus, feces, urine, vaginal smears, throat cul-
tures, and specimens from operating room). Interpretation of
results. Charting.
VIII. Examination of Feces and Gastric Contents
Normal stools' — number, form, consistency, color. Gross ap-
pearance of pathological stools, with mucus, pus, blood, para-,
sites, calculi, foreign bodies. Clinical significance. Purpose
of commoner tests. Appearance of normal stomach contents,.
Nature of tests. Charting.
IX. Examination of Urine.
Appearance of normal urine — quantity, color, turbidity, odor,
reaction, specific gravity, and constituents. Abnormal urine
• — conditions producing changes in composition, quantity, spe-
cific gravity, etc. Nature of chemical tests — for sugar, albu-
min, indican, and bile. Nature of microscopic tests — for crys»
tals, pus, casts, bacteria, etc. Charting.
X. Laboratory Period
Students divided into groups make simple tests of normal and
abnormal urine.
88 OUTLINES OF SUBJECTS
METHOD OF TEACHING
1. Classes should be held in the pathological laboratory or
museum where students can be shown specimens illustrating
the conditions and processes described. Lantern slides can
also be used to great advantage.
2. This course is a continuation of the courses in Anatomy,
Bacteriology, and Chemistry which were given in the prepara-
tory term, and is intended to serve as a basis for the courses in
Medical and Surgical Nursing. It should therefore be corre-
lated closely with these subjects.
3. It is important that pupils should get a good command of
all the ordinary terms used in describing disease conditions —
their spelling, pronunciation, and their exact meaning. Hence
it is advisable to have brief written and oral reviews and quizzes
when possible.
ILLUSTRATIVE MATERIAL
Pathological specimens, slides, charts, X-ray photographs,
and illustrations from books. Microscopes.
TEXT AND REFERENCE BOOKS
Roberts: Bacteriology ahd Pathology for Nurses.
Sedgwick: Principles of Sanitary Science.
Roger: Principles of Medical Pathology.
Adami and McCrea: Textbook on Pathology.
Wells: Chemical Pathology.
Henry: A Nurse's Handbook of Medicine.
Emerson: Essentials of Medicine.
Councilman: Disease and Its Causes. (Home University
Library)
Mackenzie: Health and Disease. (Home University Library).
Mackenzie: Symptoms and their Interpretation.
Medical Dictionaries.
See also books on Bacteriology, Medicine, Surgery, and
Hygiene.
Nursing In Medical Diseases
TIME: 20 hours, divided as follows:
Lectures a.nd clinics by physicians — 10 one-hour periods.
Classes and demonstrations by nurse instructor — 10 one-
hour periods. Given in the second half of the first year.
OBJECTS OF COURSE
1. To give the nurse a practical understanding of the causes,
symptoms, prevention and treatment of the commoner medical
diseases, so that she may intelligently care for her patients, and
give skilled assistance to the physician.
NURSING IN MEDICAL DISEASES 89
2. To give her skill and precision in the administration of the
more advanced nursing treatments and to make her a keen
observer and reporter of the symptoms of disease and the effects
of treatments.
OUTLINE OF LECTURES AND CLASSES
I and III. (Lectures) Diseases of the Blood, Heart and Circulatory System
Anaemia, leukaemia, chlorosis, pericarditis, endocarditis,
myocarditis, valvular diseases, arteriosclerosis, aneurism,
phlebitis.
II and IV. (Classes) Quiz on lectures. General nursing measures used
in above conditions — diet, drugs, appliances, etc. Symptoms
to be observed. Special treatments. Administration of drugs
by hypodermic. Hypodermoclysis, transfusion, and intra-
venous. Saline infusion.
V and VII. (Lectures) Diseases of the Respiratory System
Pneumonia, broncho-pneumonia, pleurisy, empyema, pneu-
mo-thorax, oedema, bronchitis, bronchial asthma, etc.
VI and VIII. (Classes) Quiz on lectures. General nursing measures re-
quired in above conditions. Review treatments such as in-
halations, croup-tent, irrigations, oxygen, etc., adding, cupping,
actual cautery, cantharides, leeches, and special counter-
irritants. Administration of pneumonia serum.
IX, XI, XIII. (Lectures) Diseases of the Gastro-Intestinal Tract and Acces-
sory Organs
Gastritis, dilatation of stomach, duodenal ulcer, carcinoma
of stomach, haematemesis, gastric neurosis, constipation, diar-
rhoea, mucous colitis, chronic appendicitis, ascites, jaundice,
cirrhosis and carcinoma of the liver, etc. (Typhoid should be
included here if pupils are likely to care for such cases early.
See communicable diseases.)
X, XII, and XIV. (Classes) Quiz on lectures. General nursing measures
required in above conditions. Special treatments — test meals,
lavage, gavage, nasal feeding, intestinal irrigations, procto-
clysis, rectal feeding. Antipyretic measures — cold sponge,
slush bath, cold pack.
XV, XVII, and XIX. (Lectures) Diseases of the Urinary Tract and
Constitutional Diseases
Nephritis, uraemia, cystitis, rheumatism, gout, diabetes,
and diseases of the special glands.
XVI, XVIII, and XX. General nursing measures required in above con-
ditions. Catherization, bladder irrigation, instillation, cysto-
scopic examination. Diaphoretic treatments — hot pack, vapor
and hot air baths, medicated baths.
NOTE. If it is impossible to combine the medical lecture
and nursing classes in this way for each group as it finishes the
preliminary course, it is suggested that the nursing classes be
90 OUTLINES OF SUBJECTS
given separately to each group, and that all groups be combined
for the medical lectures. Where the medical lectures have to be
postponed till the second year, the nursing classes should in-
clude a summary of the principal medical diseases such as is
found in most nursing text books. The course in pathology
should precede or accompany the course in medical nursing.
Practical experience in the general medical wards should be
given early to all pupils, as it is fundamental to all the special
branches of nursing.
METHODS OF TEACHING
1. The clinical method of teaching medical diseases is to be
preferred wherever it is possible. Lectures and classes should
be illustrated constantly by reference to patients in the wards
and nurses quizzed on the cases from their own wards. Short
written reports on interesting cases may be read in class by
pupils.
2. The anatomy and physiology of each system should be
assigned for review before taking up the diseases of each system.
Quizzes should include previous related work in bacteriology,
hygiene, materia medica, dietetics, etc.
3. In the short time allowed it will not be possible for nurses
to practice the nursing procedures in the class-room. However
each nurse should be given an opportunity as soon as possible,
to carry out each procedure on the ward. No treatment should
be given the first time without observation by the head nurse
or instructor. The pupil's card should be marked up when the
treatment has been given satisfactorily and care should be
taken to see that no important procedure is omitted.
4. Charting should be emphasized in connection with every
lesson and typical charts studied in connection with the differ-
ent diseases.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Laboratory specimens showing diseased organs, charts,
diagrams, X-ray plates, lantern slides, skeleton, bones, etc.
Demonstration room equipment.
TEXT AND REFERENCE BOOKS
Emerson: Essentials of Medicine.
Robb: Nursing Principles and Practice.
Maxwell-Pope: Practical Nursing.
Sanders: Modern Methods in Nursing.
Wheeler: Nursing Technique.
Osier: Practice of Medicine.
Hughes: Practice of Medicine.
Stevens: Practice of Medicine.
NURSING IN SURGICAL DISEASES 91
Rosenau: Preventive Medicine and Hygiene.
Hare: Practical Therapeutics.
H^nsdale: Hydrotherapy.
Baruch: Principles and Practice of Hydrotherapy.
Brunton: Lectures on the Action of Medicines.
Farr: Internal Medicine.
Lee: Scientific Features of Modern Medicine.
See also reference books on Pathology, Materia Medica,
Dietetics, etc.
Nursing in Surgical Diseases
TIME : 20 hours divided as follows :
Lectures or clinics, conducted by a surgeon — 10 hours.
Nursing classes, quizzes and demonstrations, conducted by
an expert surgical nurse — 10 hours.
OBJECTS OP COURSE
1. To give the pupil nurse a good general idea of the nature
of the principal surgical diseases, their symptoms and treat-
ment, so that she may care for surgical patients intelligently,
be of the greatest possible assistance to the surgeon in dressings
and surgical treatments, and be able to act promptly and wisely
in emergencies.
2. To give her skill in elementary surgical procedures and
bandaging, and to establish good habits of surgical technic.
OUTLINE OP LECTURES AND CLASSES
I. (Lecture) Introduction
History of antiseptic and aseptic surgery. Microorganisms
specially concerned in wound infections. Sources and modes of
infection. Surgical nomenclature. Outline of the surgical
field. General principles of modern surgery.
II. (Class) Essential qualifications for success in surgical nursing.
Surgical materials and their preparation. Sterilization of
surgical instruments and dressings. Skin disinfection and
surgical toilet. Care of the dressing carriage and dressing room.
III. (Lecture) Wounds and Wound Infections
Kinds of wounds — accidental and operative — clean and
infected. The healing process. Pathological conditions — in-
flammation, suppuration, necrosis, gangrene, septicaemia,
pyaemia, erysipelas, tetanus. Burns and scalds.
IV. (Class) Surgical dressings in clean and infected wounds.
Wet dressings. Packing, drainage, and special applications.
Removal of sutures. Treatment of contusions. Nursing care
of burn cases. Setting up of surgical trays for various kinds of
dressings.
92 OUTLINES OF SUBJECTS
V. (Lecture) Surgical Emergencies
Hemorrhage — causes, symptoms, and treatment. External
and internal hemorrhage. Shock — causes, symptoms and
treatment. Theory and technic of anoci association.
VI. (Class) Methods of controlling hemorrhage by digital pres-
sure, position, toruniquet, etc. After treatment of hemorrhage.
Prevention and treatment of shock.
VII. (Lecture) Minor Surgical Procedures
Local incisions for abcesses, empyema, tracheotomy. Tech-
nic of exploration, lumbar puncture, phlebotomy, aspiration,
paracentesis, etc. Local anaesthetics.
VIII. (Class) Preparation for local incisions and operations and
after care. Provision for drainage. Biers cups.
IX. (Lecture) Major Surgical Operations and Surgical Complica-
tions
Preparation of patient for operation. General care during
and after operation. Post-operative complications — nausea,
vomiting, tympanites, auto-intoxication, pulmonary and
kidney complications, hemophilia, thrombosis, embolism, phle-
bitis, etc.
X. (Class) Review ether-bed, Fowler's position and general points
as to routine nursing care and treatment in major operations.
Observation of symptoms. How to keep surgical charts and
records. Treatment of surgical complications.
XI. (Lectures) Surgical Conditions Involving Bony and Muscular
Systems
Fractures, dislocations and sprains. Amputations of ex-
tremities. Necrosis and osteomyelitis. (Orthopedic conditions
discussed in special course.)
XII. (Class) Review of fracture bed, splints, extensions, etc.
Preparation and after care rh each type of operation or injury,
especially fractures of skull, spine, pelvis, and compound
fractures. Special bandages — Velpeau, stump, ankle, etc.
Strapping for sprained ankle, knee, etc.
XIII. (Lecture) Surgical Conditions of the Alimentary Tract and
Accessory Organs
Common operative procedures involving stomach, spleen,
liver, and intestines. Operations for ulcer and cancer of stom-
ach and intestines, intestinal obstruction, tubercular peri-
tonitis, appendicitis, hernia, gallstones, etc.
XIV. (Class) Preparation for above, procedures and after care in
each type of operation. Bandages and dressings. Special
nursing care of fecal fistula, gall-bladder and hernia cases.
Charting.
XV. (Lecture) Surgical Conditions of Thorax and Back
Operations on chest, breast and kidney, including sarcoma,
carcinoma, cysts, tumors, stone, etc. (Brief survey of surgery
of genito-urinary tract given here. To be treated more fully
later in a special course.)
NURSING IN COMMUNICABLE DISEASES 93
XVI. (Class) Preparations and after care in each type of operation.
Special bandages and dressings. Charting.
XVII. (Lectures) Surgery of the Head and Spinal Cord
Surgical conditions of brain and spinal cord, mouth, tongue,
and thyroid gland.
XVIII. (Class) Preparation and after care in each type of operation.
Special dressings and bandages. Charting.
XIX. (Lecture) Plastic Surgery
Grafts — bone and skin. Surgical treatment of hare-lip,
cleft palate, etc.
XX. (Class) Preparation and after care in each type of operation.
Special dressings and bandages.
METHOD OF TEACHING
Follow same general method as that outlined under medical
nursing.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Dressing carriage and full equipment of surgical materials.
Trays for various types of surgical dressings, hypodermoclysis,
preparation, etc. Samples of special instruments and appara-
tus. Lantern slides, X-ray plates, skeleton, etc. Anatomical
and first aid charts.
TEXT AND REFERENCE BOOKS
Parker and Breckenridge : Surgical and Gynecological Nursing.
Fowler: Operating Room and Patient.
Howell: Surgical Nursing and Hospital Technique.
Rose and Carless: Manual of Surgery.
DaCosta: Modern Surgery — General and Operative.
Morrow: Immediate Care of the Injured.
Saleeby: Surgery and Society.
Crile: Anoci-Association.
See also under Elementary Bandaging and First Aid.
Nursing in Communicable Diseases
TIME : 20 hours — divided as follows :
Medical lectures or clinics by a physician — 9 hours.
Medical classes and demonstrations, by a nurse who is a
specialist in the field — 9 hours.
Lectures on social aspects by social service worker or special-
ist in this phase of the subject — 2 hours. Course to be given
in the earlier half of the second year.
OBJECTS OF COURSE
1. In most infectious diseases, the nursing care is the most
important part of the treatment, hence the nurse needs to be
thoroughly informed on the nature of these diseases, and on
every point that would help her to give intelligent nursing
care and to prevent the spread of disease to others.
94 OUTLINES OF SUBJECTS
2. Especially in public health nursing, the nurse is expected
to detect the early signs of the infectious diseases, so she ought
to be very familiar with the symptoms of all the commoner
infections, and should know the local regulations for the han-
dling of such cases.
3. It is very important that she should also recognize the
social and economic aspects of this whole question of prevent-
able diseases, and should appreciate her responsibilities and
opportunities in the campaign to eradicate them.
OUTLINE OF LECTURES AND CLASSES
I. (Lecture) Typhoid Fever
Introduction to the study of fevers. General clinical fea-
tures, causes, stages and general lines of prophylaxis and treat-
ment. The causes, modes of transmission, incubation period,
symptoms, varieties, complications, aftereffects, and treatment
of typhoid.
II. (Class) Quiz on lecture. Sanitation of sick-room and hygiene
of patient, family and nurse, Patient's toilet, antipyretic
measures, diet, and general nursing care in fevers. Prepara-
tion for Widal and anti-typhoid serum. Precautions and treat-
ment in hemorrhage, perforation, tympanites, etc. Quaran-
tine and personal precautions
III. (Lecture) Scarlet Fever, Measles, German Measles
General features of the exanthemata. Latest conclusion.-,
regarding causes and methods of infection. Periods of incuba-
tion, immunity, symptoms, types and characteristics of eacli
disease. Complications, after effects, and treatment. Gener.il
precautions and Board of Health regulations.
IV. Quiz on lecture. General technic of aseptic nursing, disinfec-
tion, isolation, etc. Prevention of cross infections. Nursing
care in above diseases. Special care of mouth, nose, throat,
eyes, and ears. Precautions as to rest, warmth, diet, and bath-
ing. Nursing treatment of nephritic complications, otitis
media, endocarditis, etc. Charting.
V. (Lecture) Small-pox, Co>v-pox, Chicken-pox, and Erysipelas
History of small-pox. Cause, mode of transmission, incuba-
tion period, symptoms, types, stage of eruption, toxemia,
complications, after effects, and treatment of each disease.
Degree of quarantine and infectivity.
VI. (Class) Quiz on lecture Nursing care in above diseases as to
rest, bathing, diet, etc Preparation for vaccination and dress-
ing. Local applications of cold, antiseptics, etc. Irrigation of
eyes and prevention of pitting in small-pox. Methods of dis-
infection and precautions. Care of body after death.
VII. (Lecture) Diphtheria, Tonsillitis and Septic Sore. Throat
History of diphtheria. Causes, sympton.s, complications,
after effects, and treatment of each disease. Board of Health
regulations.
NURSING IN COMMUNICABLE DISEASES 95
VIII. (Class) Quiz on lecture. Nursing care and management of
above diseases. Local throat treatments. Preparation for
giving antitoxine, intubation, tracheotomy, Schick test.
After-care of intubated cases. Heart precautions. Vincent's
angina. Use of mouth gag and feeding. Care of tubes — thread-
ing, cleaning, etc.
IX. (Lecture) Influenza, Whooping Cough, Mumps and Colds
History, causes, modes of transmission, symptoms, complica-
tions, after effects, treatment, etc. Board of Health regula-
tions.
X. (Class) Quiz on lecture. Nursing care and management of
above. Review of hot and cold applications, counter irritants,
croup-tent, etc. Precautions. Technic of isolation and dis-
infection in a private home for more severe and milder infec-
tions.
XI. (Lecture) Cerebro-Spinal Meningitis, Infantile Paralysis
Causes, modes of transmission, infectivity, symptoms, com-
plications, after effects, and treatment. Board of Health
regulations.
XII. (Class) Quiz on lecture. Nursing care in the above diseases.
Importance of surroundings, position and support. Care in
convulsions. Preparations for lumbar puncture. Precautions
and disinfection.
XIII. (Lecture) Malaria, Yellow Fever, Typhus, Amoebic Dysentery,
Bubonic Plague and Hook-worm
History, causes, mode of transmission, symptoms, complica-
tions, after effects, and treatment. Recent campaigns for
eradication of malaria, plague, hook-worm, etc. Maritime
quarantine.
XIV. (Class) Quiz on lecture. Nursing care in above. Baths, diet,
intestinal irrigations, and specifics. Measures for destruction
of insects. Camp sanitation.
XV and XVI. (Lecture) Tuberculosis
History of tuberculosis, and modern campaign for prevention
and control. Exciting and predisposing causes, sources and
modes of infection, pathology, types and infection, early
symptoms and course of disease, complications and accidents,
treatment, Board of Health regulations.
XVII and VIII. (Classes) Quiz on lectures. Nursing care in tuberculosis.
Hygiene, rest, diet, and fresh air. Provision for out-of-door
sleeping. Klondike bed. Methods of disinfection. Care of
advanced cases. Technic of special treatments — strapping,
blistering, cupping, aspiration, pneumothorax. Care in hem-
orrhage. Temperature taking and charting. Nurse's 'care of
herself.
XIX and XX. (Lectures) Social, Economic, and Educational Factors in Pre-
vention and Treatment of Communicable Diseases
Problems of industry, housing, and poverty in relation to
infectious diseases, particularly tuberculosis. Institution?- for
96 OUTLINES OF SUBJECTS
the care of such patients. Education and care of patients in
their hbmes. Occupation and employment. Problems of re-
lief. The out-door clinic. Reports and records. Methods of
instruction. Relation of immigration to communicable dis-
eases. Publicity methods.
NOTE — If the course in venereal diseases cannot be given
separately, at least two lectures in this subject should be in-
cluded here.
METHODS OF TEACHING
1. The method advocated is much the same as that followed
in medical nursing.
2. A visit to the Board of Health laboratories would be
extremely profitable during this series of classes; also exhibits
in preventive methods.
3. Experience in an infectious hospital and in tuberculosis
nursing is of the very greatest importance, especially for all
those who may engage in any form of Public Health work.
Experience in the out-patients' department is also invaluable.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Bacteriological slides and cultures, charts, models, etc.
Equipment for demonstration of all practical procedures.
TEXT AND REFERENCE BOOKS
Lee: Scientific Features of Modern Medicine.
Paul: Nursing in the Acute Infectious Fevers.
Register: Practical Fever Nursing.
Wilson: Fever Nursing.
Wilcox: A Manual of Fever Nursing.
Emerson: Essentials of Medicine.
Roseneau: Preventive Medicine and Hygiene.
McNutt: Manual for Health Officers.
Knopf: Tuberculosis a Curable and Preventable Disease.
Newsholme: The Prevention of Tuberculosis.
Otis: The Great White Plague.
Crowcll: Tuberculosis Dispensary Method and Procedure.
Publications of Boards of Health.
See also under Medical Nursing, Bacteriology and Public
Sanitation.
Nursing in Diseases of Infants and Children
TIME: 20 hours — divided as follows:
Lectures or clinics by pediatrician — 7 hours.
Classes and demonstrations by nurse (head of children's
ward) — 7 hours.
NURSING IN DISEASES OF INFANTS AND CHILDREN 97
Lectures on social and psychological topics (special lectures)
— 2 hours.
Classes and demonstrations in infant feeding by nurse or
dietitian — 4 hours.
The course to be given early in the second year.
OBJECTS OP THE COURSE
1. To help nurses to understand something of the physical
and mental development of normal children and the essential
principles of child hygiene and management, so they may
intelligently care for normal children and teach others to care
for them properly.
2. To teach them the principal diseases which affect children,
what their special manifestations are, and how to adapt nurs-
ing measures to meet the needs of sick children.
3. To make the pupil nurse intelligent, skillful and exact in
the preparation of infant feedings, and to emphasize the im-
portance of proper feeding as a therapeutic measure in the
diseases of infancy.
4. To give a good sound basis for later work in connection
with milk depots, baby welfare, school-nursing and other fields
of work where knowledge and skill in children's nursing are
of essential importance.
5. To give pupils some appreciation of the causes and social
aspects of infant mortality, and secure their interest and
cooperation in the conservation of child life.
OUTLINE OF LECTURES AND CLASSES
I. (Lecture) The Physical Development of the Normal Child from
Birth to Adolescence
How the child differs from the adult. Appearance, weight,
height, muscular development of organs and special senses at
various ages. Normal dentition and possible complications.
Normal excretions. Relation between physical and mental
growth. Hygiene of infancy and childhood. Hygiene of
adolescent boy and girl.
II. (Class) Physical Care of the Normal Infant
Bathing, exercise, fresh air, sleep and clothing. The han-
dling of the baby and run-about child. The nursery — its fur-
nishings and care. The daily regime at different stages. Quali-
fications of a good children's nurse.
III. (Lecture) The Feeding of Normal Children
Feeding during the first year. The very great importance of
breast feeding and methods of encouraging and promoting it.
Artificial feeding. Conditions to be met. Modified milk.
Formulae adapted to the infant at various stages. Feeding
of the premature infant. Diet through later stages of child-
hood. Food habits.
98 OUTLINES OF SUBJECTS
IV. (Class) Quiz on above. Position and care of infant in breast
feeding. Care of feedings on the ward, and administration.
Feeding delicate infants and run-about children. Making diet
attractive to older children.
(Classes XVII to XX to run parallel if possible.)
V. (Lecture) Disorders of the Digestive Tract in Infancy and Child-
hood
The sick baby — variations in symptomatology from adults.
Diseases of nutrition, digestion and metabolism — marasmus,
rachitis, etc. Their causes, symptoms, treatment and con-
valescent care. Relation of diet to gastro-intestinal disorders.
(Distinguish clearly between the infant up to 2 years and over.)
VI. (Class) Quiz on lecture. Observation and description of symp-
toms in babies and older children. Difference in handling and
nursing care of sick children. Gavage, nasal feeding, lavage,
and enemata, as applied to small babies and older children.
Care of buttocks. Administration of medicines to children.
Collection and care of specimens.
VII. Lecture) Disorders of the Respiratory System in Infancy and
Childhood
Bronchitis, pneumonia (broncho and lobar), pleurisy, empy-
ema, croup, tuberculosis. Relative gravity of symptoms in
child as compared with adult. Treatment and convalescent
care.
VIII. (Class) Quiz on lecture. Observation and nursing care.
Fresh-air treatment. Out-door bed and clothing. Helio-
therapy. Croup-tent. Preparation for aspiration of chest.
Restraint of child during treatments.
IX. (Lecture) Infectious Diseases in Infancy and Childhood
Susceptibility of children to infectious diseases and differ-
ences in reaction from adults. Sources and modes of infection
in hospital wards. Prevention of spread of diphtheria, scarlet
fever, influenza, common colds, etc. Control of vaginitis and
isolation of specific diseases in children's wards. Typhoid
in children. After-effects of various infections.
X. (Class) Quiz on above. Aseptic precautions in nursing care
of children, with special reference to utensils, thermometers,
etc. Care of special precaution and isolation cases. Treatment
of infected eyes in infant. Modifications of other treatments
with infants and children — baths, packs, hot and cold applica-
tions, etc.
XI. (Lecture) Constitutional and Nervous Disorders in Infancy arid
Childhood
Principal causes of nervous disorders, hysteria, chorea, epi-
lepsy, convulsions, "tantrums," etc. Mental defects — idiocy,
imbecility, cretinism and mutism. Rheumatism, nephritis,
and chronic heart diseases in children. The significance of
"growing pains."
NURSING IN DISEASES OF INFANTS AND CHILDREN 99
XII. (Class) Quizonabove. Observation and management of nerv-
ous children. Mental hygiene. Care of defective children.
Daily re*gime for heart cases. Modifications of common treat-
ments— hot pack, mustard bath, cupping and counter irritants,
etc., for children.
XIII. (Lecture) Surgical Conditions in Infancy and Childhood
Congenital and acquired deformities and malformations —
cleft palate, hare-lip, spina bifida, obstruction, imperforate
anus, etc. Phimosis, circumcision, umbilical hernia, intus-
suception. Effects of anaesthetics on children. Early symp-
toms of spinal and other deformities. Burns.
XIV. (Class) Quiz on above. Care of such cases before and after
operation, including special dressings and treatments. Feed-
ing and restraint. Nursing care of burn cases. (For care of
orthopedic conditions see later course.)
XV. (Lecture) Social Aspects of Children's Diseases. (By head of
Social Service Department or special lecturer.)
The problem of infant mortality — what it means to the com-
munity. Causes of high death rate in infants. Home versus
institutional care of infants. Effects of child labor, mal-
nutrition, bad housing, etc. on vitality and health of children.
Movements for conservation of child life. (An excursion to a
milk station or orphanage, day nursery or foundling home
might supplement this lecture.)
XVI. (Lectures) The Psychology of Childhood (Given by a teacher
or other expert in child psychology — should be introduced
before Lecture XI if possible.)
Mental development of the normal child from birth to adoles-
cence. Instincts and capacities as they appear in normal
development. Characteristic phases of development in boys
and girls. How to interest and manage children at various
stages. Abnormal types. How to deal with pernicious habits.
The psychological and therapeutic value of play. Some prin-
ciples of education. (This lecture might be supplemented by
one or more classes by a kindergartner dealing with appro-
priate plays, games and amusements for children, good pictures
and stories for children at different ages, and the way of telling
an interesting story.)
The following classes in infant feeding should run parallel
to topics III to VI if possible.
XVII. (Class) Utensils
Sterilizer, pasteurizer, pitcher (aluminum), bottle rack,
feeding bottles, Chapin dipper, glass funnel, graduate, ounce
measuring glass, thermometer, bottle brush, nipples, skewer,
etc. Kinds and reasons why some are better than others.
Substitutes for home use — ex. quart dipper for graduate and
tablespoon for ounce measuring glass, etc.
100 OUTLINES OF SUBJECTS
XVIII. (Class) Materials
Lime water — its composition and action. Sugars — lactose,
maltose, dextri-maltose, cane sugar — their composition and
action. Milk — cows' milk as compared with human milk.
Composition of each and reasons for modifying. Sources of
supply and methods of handling certified milk. Reasons for
using and Board of Health regulations governing certified
milk. Pasteurized milk, — method of pasteurization, reasons
for pasteurizing and objections. Percentage milks — table show-
ing composition of bottled milk at different depths. Starches
— barley flour, oatmeal flour — their composition and action.
XIX. (Class) Formulae
Simple dilution with boiled water, whole milk, percentage
milk, milk sugar and lime water. Simple dilution with cereal
waters — rice, oatmeal or barley — action of each. Splitting of
protein by (1) coagulation of casein and using of whey. Con-
stituents of whey. (2) Coagulation of casein and using of
casein' — Eiweiss. Fat free milk. Predigested foods. Pepsin
or pancreatin extract. Patent foods — their objections and
uses. Malt soup mixtures. Use of strained cereals, broths and
vegetable soups in infant feeding.
XX. (Class) Technic
Care of hands. Care of milk after delivery. Care of milk
after modifying. Care of utensils — to be used only for formu-
lae— to be thoroughly washed and sterilized. Care of nipples
and bottles. Accuracy in measurements. Preparation of
feedings — bottles filled with exact amount required for feed-
ings. Sealing with sterile cotton handled with forceps or patent
caps. Method of labelling for hospital use. Method of apply-
ing nipples.
METHODS OF TEACHING
1. Follow the general method outlined under medical nursing.
The clinical method is infinitely superior to the simple lecture,
and should be adopted in this subject if at all possible. Every
opportunity should be taken to have pupils observe and handle
actual cases.
2. Practical experience in the care of children is of paramount
and increasing importance for every nurse. Such experience
should include the care of very young children as well as those
of later years, and in medical and feeding cases as well as surgi-
cal and orthopedic cases. Dispensary experience in the chil-
dren's clinic is also invaluable, especially for those who expect
to go into school or milk station work or any form of Public
Health work.
3. The nursing procedures as applied in the children's ward
are so different in many respects from the methods employed
in adult wards, that it will be necessary to discuss those modi-
GYNECOLOGICAL NURSING 101
fications and adaptations in detail and to demonstrate them for
pupils. These demonstrations can be given in the ward or in
the demonstration-room.
4. Work in this course should be correlated closely with
courses in general medical and surgical nursing, dietetics, or-
thopedics, etc.
5. The classes in infant feeding should be held in the diet
kitchen or milk laboratory where all the materials and utensils
can be seen and demonstrated. In the limited time assigned,
no individual laboratory work could probably be covered, but
each student should have a period of practical experience in the
milk-room in connection with her training in the children's
wards.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
Charts, models, pictures, utensils and materials for infant
feeding, food-charts, etc.
TEXT AND REFERENCE BOOKS
McCombs: Diseases of Children for Nurses.
Ramsay: Care and Feeding of Infants and Children.
Holt: Diseases of Infancy and Childhood.
Holt: The Care and Feeding of Children.
Chapin and Pisek: Diseases of Infants and Children.
Brown : The Baby.
Grulee: Infant Feeding.
Morse: Care and Feeding of Children.
Morse and Talbot: Diseases of Nutrition and Infant Feeding.
Kerley: Practice of Pediatrics.
Kerley: Short Talks to Young Mothers.
Starr: Hygiene of the Nursery.
West: Care of Children and Prenatal Care — Pamphlets from
Children's Bureau, Washington, D. C.
Rose: Feeding the Family.
Smith: Baby's First Two Years.
Kirkpatrick: Child Study.
Kirkpatrick: Individual in the Making.
Amusements for Convalescent Children — from New York
State Board of Health.
American Journal Diseases of Children.
American Journal for Care of Cripples.
See also under Special Therapeutics, Orthopedic Nursing
Obstetrical Nursing, etc.
Gynecological Nursing and Diseases of the Male Genito-Urinary Tract
TIME : 10 hours — divided as follows —
Lectures or clinics by physician specialist in gynecology and
genito-urinary diseases — 5 hours. Quizzes, classes and demon-
102 OUTLINES OF SUBJECTS
strations conducted by the head nurse of the gynecological
ward — 5 hours. Course to be given in the Second Year.
OBJECTS OF COURSE
1. It is intended, through the lectures, to give the student an
intelligent understanding of the diseases of the genito-urinary
tract, and the various forms of operative treatment for surgical
conditions of the tract.
2. The classes and demonstrations are for the purpose of
enabling the student to become more familiar with the partic-
ular nursing procedures in this branch of work.
OUTLINE OF LECTURES AND CLASSES
I. (Lecture) Introduction
Brief history of gynecology as a specialty. Anatomy and
physiology of the reproductive organs in review. Menstrual
and reproductive functions of organs. Puberty and the meno-
pause. Sterility and its causes. Abnormal menstruation-
causes and treatment. Menstrual hygiene.
II. (Class) Quiz on anatomy and physiology of pelvic organs.
Review on surgical materials especially those used in gyne-
cological and G. U. dressings and treatments. Equipment and
care of the dressing-rooms for gynecological and genito-urinary
cases. Nurses' relation to educational and ethical problems
arising from this special type of work.
III. (Lecture) Diseases of the Reproductive Tract
Sources of infection, symptoms, treatment. Relation of
venereal disease to infection. Displacement of organs. Mal-
formations. Tumors of the pelvic organs, benign and malig-
nant. Early symptoms and cancer. Importance of early diag-
nosis and treatment. Tumor complications.
IV. (Class) Quiz on causes, treatment and nursing care in above
conditions. Reception of patient. Observation of symptoms.
Importance of mental attitude of patient. Review of gyne-
cological treatments — douches, catherization, etc. Nurse's
responsibility in the early diagnosis of malignant tumors.
Opportunities for educational work in the prevention of cancer.
V. (Lecture) Diseases of the Urinary Tract
Malformations, foreign bodies, infections, fistulae, tumors,
stricture, calculi and diseases of the external genitalia. Ex-
aminations, treatments and operative measures used in above
conditions.
VI. (Class) Preparation for examinations — abdominal, pelvic,
cystoscopic. Discussion of nursing care and technique in
relation to important treatments. Nursing care of drainage
cases.
VII. (Lecture) Gynecological Operations
The various postures, and instruments used. Protection of
patient. Assistance to physician. Preparation for operation
ORTHOPEDIC NURSING 103
— the skin — the digestive tract. The main types of minor
operations and the nursing measures required to insure success-
ful results.
VIII. (Class) Quizron major and minor operations and vocabulary
in connection. Preparation of patient for operation, local
and general. Importance of comfortable positions during
operation and in post-operative care. Care of skin and binder.
Importance of air and nourishment. Drugs used in treatment.
Dressings in each type of operation.
IX. (Lecture) Gynecological Operations
Vocabulary. Major operations, including those for mal-
formations and displacements. Injuries. Inflammatory con-
ditions and new growths. Post-operative treatment and com-
plications. Post-operative care of patient.
X. (Class) Observation of first symptoms after operation.
Methods of preventing and meeting complications and emer-
gencies — shock, hemorrhage, infected stitches, retention of
urine, burns by heat, iodine, anesthetic or acid, phlebitis, etc.
METHODS OF TEACHING
The general plan to be followed is outlined under Surgical
Nursing.
EQUIPMENT AND iLi/csTRATiyE MATERIAL
Bony pelvis of skeleton, muscular pelvis of mannikin with
organs in position ; pathological specimens of tract from labora-
tory.
TEXT AND REFERENCE BOOKS
Parker and Breckinridge : Surgical and Gynecological Nursing.
Cragin: Essentials of Gynecology.
Kelly: Medical Gynecology.
Kelly: Operative Gynecology.
Davis: Obstetric and Gynecologic Nursing.
MacFarlane: Gynecology for Nurses.
See also books under Anatomy and Physiology, Obstetrics,
Hygiene and Venereal Diseases, etc.
Orthopedic Nursing
TIKE : 10 hours divided as follows : —
Lectures or clinics by orthopedic specialist' — 4 hours.
Classes and demonstrations by a nurse with special training
in orthopedic work— 5 hours.
Lecture on social aspects of orthopedic work by head of social
service department' — 1 hour. Given in the later part of the sec-
ond year.
104 OUTLINES OF SUBJECTS
OBJECTS OF THE COURSE
1. To give the nurse a definite idea of orthopedic nursing as
distinct from general surgical nursing, with a knowledge and
practice in the use of various splints and apparatus peculiar to
orthopedic work.
2. To teach her the cause and prevention as well as the care
of orthopedic conditions, and the subsequent needs of the indi-
vidual resulting from what at best is generally a long contin-
ued illness, whether it be chronic or acute.
3. To give her a better understanding of certain educational
and social problems concerning the physically deficient children
in our schools, and a keener interest in public health and tuber-
culosis work.
OUTLINE OF LECTURES AND CLASSES
I. (Lecture) Orthopedic Conditions Due to Tuberculosis
Anatomy and histology of bone. Deformities due to tubenju-
losis and the care and treatment of the same. General hygiene.
Congenital malformations and deformities. Dislocations,
club feet, etc.
II. (Class) Orthopedic apparatus- — frames, traction splints,
Thomas splint, caliper splints, braces, strappings (adhesive),
etc. Practice in the application of apparatus, frames and ex-
tensions. Bed making, bathing and general nursing care for
such patients.
III. (Lecture) Diseases Due to Faulty Nutrition
Causes, symptoms and treatment of rickets, bow legs, breech
knees, etc. Prevention. Dietetic and hygienic care.
IV. (Class) Quiz on lecture. Practice in application of appara-
tus— splints, adhesive strappings, for flat foot and other strains.
V. (Lecture) Deformities of the Spine
Causes, symptoms, and treatment of Pott's disease, curva-
tures, etc. Orthopedic exercises and corrective work.
VI. (Class) Quiz on lecture. Practice in general exercises and
special gymnastic work. Special scoliosis clinics. Possibility
of home treatment.
VII. (Lecture) Infantile Paralysis. Spastic and other paralyses.
After-care. Muscle-training. Splints and other appliances.
VIII. (Class) Quiz on lecture. Use of the plaster-of-paris bandage.
Practice in making and applying.
IX. (Lecture) Social Problems Connected urith Orthopedic Work.
Special problems of education and training of physically
handicapped. Employment for cripples. Special schools and
institutions for crippled children. Work of the school nurse
and visiting nurse in discovering and dealing with orthopedic
cases. Cooperation with social and educational agencifes.
X. (Class) Practice in the making and application of the plaster-
of-paris bandage.
OBSTETKICAL NURSING 105
METHOD OF TEACHING
1. The method of teaching is by lecture, demonstration, reci-
tation and practice, all lectures and demonsrations being illus-
trated by clinical material from the wards. An effort should be
made throughout to emphasize the nursing side of the various
problems presented.
2. It is particularly rlecesssary that the nurse have ample
practice in the handling of apparatus, and the actual applica-
tion of splints, frames, plaster and the like, under careful super-
vision, before she be allowed to do the work for the patient.
It is presupposed that she shall already have been well in-
structed in bandaging, massage and general surgical technique.
To be complete her ward experience should be supplemented
by outside visiting or dispensary work, where she_may learn the
end results which in such long cases do not come to her atten-
tion in the hospital wards.
3. This course should be correlated closely with courses in
surgical nursing, in diseases of children and massage.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Plaster bandages and materials for making Bradford frames,
traction, Thomas and caliper splints, braces for breech knees,
bow legs, curvature of the spine, etc. Adhesive plaster, plas-
ter models, charts and photographs illustrating deformities.
TEXT AND REFERENCE BOOKS
Berry: Orthopedic Surgery for Nurses.
Thorndike: Orthopedic Surgery.
Bradford and Lovett : Treatise on Orthopedic Surgery.
Tubby: Deformities — including diseases of the Bones and
Joints.
See also Surgical Nursing, Nursing in Diseases of Infants and
Children, etc.
Obstetrical Nursing
TIME : 20 hours divided as follows : —
Lectures and clinics by obstetrician' — 10 hours.
Classes and demonstrations by nurse (head of obstetrical
ward preferably) — 9 hours.
Lecture on social aspects of obstetrics by social service nurse
— 1 hour.
OBJECTS OF COURSE
1. To make nurses intelligent and competent in the nursing
care of obstetrical cases, both normal and abnormal, and in the
care of small babies.
2. To enable the nurse to advise and instruct mothers in the
care of their own health both before and after child-birth, and
in the. conditions necessary for the rearing of healthy children.
106 OUTLINES OF SUBJECTS
3. To arouse an interest in obstetrical nursing and a keener
appreciation of its importance, not only to individual mothers
and babies, but to the welfare of the race.
4. To arouse an interest in the social aspects of obstetrical
work and to develop a wholesome and helpful attitude toward
such sex problems as the nurse meets in connection with her
work.
5. To establish a definite connection between previous work
in surgical technic and obstetrics.
OUTLINE OF CLASSES AND LECTURES
I. (Lecture) Introduction
Brief history of obstetrics. The place of obstetrics in medi-
cine. Responsibilities and opportunities of obstetricians and
nurses. Anatomy of female pelvis. Landmarks. Varieties of
pelvis and their relation to position and presentation. Abnor-
malities and their relation to child-birth. Review of female
organs of generation.
II. (Class) Brief quiz on anatomy of reproductive system. Out-
line of reproduction in lower animals, beginning with one-celled
animals and using the chick, the frog, and the rabbit or cat as
types. (See Marshall's Embryology, or Bigelow's Applied
Biology.)
III. (Lecture) Physiological Pregnancy
Ovulation, menstruation and impregnation. The phenomena
of pregnancy and segmentation. Nourishment of fetus1 — size
and weight at different stages. Circulation. Conditions neces-
sary for normal development. The facts about "maternal im-
pressions." Influence and determining factors in heredity.
The purpose and scope of eugenics.
IV. (Class) Quiz on lecture. The mother's preparation for her-
self as to clothing, dressings, utensils, etc. The "layette."
Newer ideals as to babies' clothing. Simplicity and economy
emphasized. The baby's cot or basket.
V. (Lecture) Changes in the Maternal Organism During Pregnancy
Signs and symptoms of pregnancy — presumptive, probable,
And positive. Duration. Methods of reckoning date of termi-
nation. Hygiene and management of pregnancy.
VI. (Class) Quiz on lecture. Pre-natal care. How to advise and
help the mother as to employment, reading, diversions, cloth-
ing, diet, etc. Importance of mental attitude. Problems in
calculation of dates. Make out suggestive diets. Routine ex-
amination of urine in pregnancy. The nurse's obstetrical outfit.
VII. (Lecture) Disorders and Diseases nf Pregnancy
Nausea, pernicious vomiting, varicose veins, oedema, anemia,
neuralgia, eclampsia, ectopic gestation, placenta praevia, abor-
tion, and miscarriage. Causes, symptoms, and treatment.
OBSTETRICAL NURSING 107
VIII. (Class) Quiz on lecture. Nursing care in above conditions.
Drill on obstetrical terms. Instruments and equipment of de-
livery-room. Making of bed for obstetrical case. Rules for
admission of obstetrical patients in the hospital.
IX. (Lecture) Mechanism and Conduct of Normal Labor
Theories concerning cause of labor. Obstetrical ether. Ni-
trous oxide or American ' ' Twilight Sleep . ' ' Signs of labor — the
three stages. Presentations. Management of each stage.
Immediate care of mother and infant.
X. (Class) Quiz on lecture. Preparation of delivery-room. Prep-
aration of patient. Technic of nursing care and assistance to
physician at each stage of labor. Duties of nurse in absence of
physician.
XI. (Lecture) Operative Delivery
Forceps delivery, breech delivery, Caesarian section and de-
structive operations. Methods of inducing premature labor.
Requirements for repair of lacerations.
XII. (Class) Quiz on lecture. Preparation for various operative
measures, and nursing care of patient before, during and after
each. Care of perineal stitches.
XIII. (Lecture) Accidents and Complications
Symptoms and treatment of post-partum and intra-partum
haemorrhage, eclampsia, heart-failure, retained placenta, etc.
Accidents and injuries to the new-born — asphyxia, haemor-
rhage, traumatisms, infections, etc.
XIV. (Class) Quiz on lecture. Nursing care of patient in above
conditions. Preparation for uterine packing, saline infusions,
hot packs, etc. The care of the baby — dressing of cord, care of
the eyes, etc. First care of the premature baby — jacket and
cot, feeding, resuscitation and use of lung motor.
XV. (Lecture) The Puerperium
Anatomical changes in uterus, cervix, vagina, and abdominal
walls. Symptoms to be observed and reported. Special at-
tention to lochia. Care of breasts and encouragement of breast
feeding. Contra-indications for breast-feeding.
XVI. (Class) Quiz on lecture. The routine nursing care of normal
cases — position, bathing, diet, application of breast and ab-
dominal binders and perineal dressings. Use of breast pump.
Massage of breast. Local applications for nipples and breasts.
The obstetrical chart. Catheterization of puerperal patient.
XVII. (Lecture) Pathological Puerperium
Puerperal septicaemia, phlegmasia dolens, mastitis, puerperal
insanity, urinary and intestinal disturbances, etc. Causes,
symptoms, treatment, and general care.
XVIII. (Class) Quiz on lecture. Nursing care of above cases and
special treatments reviewed. Preparations for intra-uterine
douche. Dressing for incision of breast. Precautions and
treatment in puerperal insanity.
108 OUTLINES OF SUBJECTS
XIX. (Lecture) Social Aspects of Obstetrical Nursing
The older and newer attitude toward child-birth. Social
problems arising in obstetrical work. The unmarried mother.
The child mother. Relation of industry to child-birth. Res-
cue homes and foundling institutions. Infanticide and abor-
tion. Blindness of the new-born. The problem of birth con-
trol. Reasons for and against the teaching of birth-control.
Legislation governing in this and other countries. The midwife
problem. The nurse's influence and responsibility in such
problems.
XX. Observation lesson or clinic to be introduced wherever it will
be most helpful — preferably in small groups. Attendance
throughout one case of labor with full report of the case.
METHODS OF TEACHING
1. The clinical method should be used as far as possible.
All specially interesting cases should be seen by nurses. As
many procedures as possible should be demonstrated in the de-
livery room.
2. The nurse should have her operating room training before
she has her practical work in obstetrics. If these lectures and
classes can not run parallel with the practical training it is
better for them to come first. The practical experience is of
very great importance and it should be as full and complete as
possible. Out-patient work is not very profitable unless care-
fully supervised by a teaching graduate nurse.
3. Correlate course in obstetrics closely with courses in bac-
teriology, gynecological nursing, surgical nursing, and nursing,
of infants and children.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
Skeleton, separate pelvis, model of baby and placenta.
Laboratory specimens of embryo and fetus at various stages.
Lantern slides illustrating reproduction.
TEXT AND REFERENCE BOOKS
De Lee: Obstetrics for Nurses.
Cooke: A Nurse's Handbook of Obstetrics.
Williams: Obstetrics.
Polak: Obstetrics.
Marshall: Vertebrate Embryology.
Bigelow: Applied Biology.
Siemens: Prospecive Mother.
Latimer: Girl and Woman.
Prenatal pamphlet published by Federal Children's Bureau.
Pamphlet on Midwives published by Committee on Blindness
of State Charities Aid, N. Y.
See also under Diseases of Infants and Children, Venereal
Diseases, etc.
NURSING IN DISEASES OF THE EYE, EAR, NOSE AND THROAT 109
Nursing in Diseases of the Eye, Ear, Nose and Throat
TIME: 10 hours, divided as follows:
Medical lectures and clinics given by specialists — 5 hours.
Nursing classes and demonstrations given by nurse specially
qualified in E. E. N. and T. work' — 4 hours.
Lecture on social aspects given by head of social service de-
partment or other qualified person — 1 hour. This course to be
given in the latter half of the second year preferably.
OBJECTS OF COURSE
1. To give nurses an understanding of the care and treatment
of the eye, ear, nose and throat in normal and abnormal condi-
tions.
2. To enable them to safely and efficiently care for patients
with diseases of these organs.
3. To arouse an interest in this branch of nursing which will
lead nurses into this field equipped with a basis for further
specialization, and for preventive and educational work.
OUTLINE OP CLASSES AND LECTURES
I. (Lecture) Diseases of the Eye
Review of the anatomy and physiology of the eye. Eye
strain — prevention and effects. Injuries of the eye. Diseases
of the lids, lacrymal apparatus and conjunctiva. Corneal ul-
cer, keratitis, iritis, glaucoma, cataract, gonorrheal ophthal-
mia, opthalmia neonatorum, and trachoma. Causes, symp-
toms and treatment of these. Usual operative procedures.
II. (Class) Quiz on lecture. Assisting with examinations of the
eye. Solutions used in treatment,' — effects, preparation, care.
Demonstrations of hot and cold eye applications, the eye irri-
gation, the preparation for dressings. Preparation of patient
for operation and after care. Nurse's duties in cases of injuries
or foreign bodies. Precautions in care of patient suffering
from communicable eye disease.
III. (Lecture) Diseases of Mouth, Pharynx and Larynx
Review of anatomy and physiology. Diseases of the teeth
and gums — pyorrhea, abscesses, etc. Effect on health. Hy-
giene of mouth and teeth. Operative procedure for correctioto
of deformities of teeth and jaws. Diseases of the tonsils and
adenoids — causes, effects, symptoms, treatment and operative
procedures. Diseases of larynx. Tumors, benign and malig-
nant. Causes, effects, symptoms, treatment and operative
procedures.
IV. (Class) Quiz on lecture. Nurse's duties in connection with
oral hygiene. Assisting with examinations of mouth, pharynx,
and larynx. Applying medication. Gargles, irrigations, in-
110 OUTLINES OF SUBJECTS
halations, etc., reviewed. Preparation of patient for operation
and after care in case of tonsillectomy, laryngectomy, trache-
otomy, etc. Control of hemorrhage.
V. (Lecture) Diseases of the Ear
Review of anatomy and physiology of the ear. Examination
of ear. Deafness — its causes and prevention. Common tests
of hearing. Diseases of the auricle and external ear (foreign
bodies, eczema, furunculosis, impacted cerumen, etc.). Dis-
eases of the middle ear — chronic and acute otitis media, mas-
toiditis, etc. Complications — cerebral abscess, meningitis,
sinus, thrombosis, etc. — causes, symptoms and treatment,
operative and non-operative.
VI. (Class) Quiz on lecture. Advice nurses may give concerning
foreign bodies, chronic discharging ears, etc. Demonstration
of hot and cold applications. The ear irrigation. Preparation
for myringotomy and incision of furuncle. Preparation of pa-
tient for mastoid operation and post-operative care. Dress-
ings, instruments and supplies used. Symptoms and signs of
complications. Xursing care of patients with cerebral abscess,
meningitis, thrombosis.
VII. (Lecture) Diseases of the Nose and Accessory Sinuses
Review of anatomy and physiology. Diseases of the nasal
tract, including acute and chronic rhinitis and deflections of
the septum' — their causes, symptoms and effect on general
health. Methods of examination and treatment, operative
and non-operative. Infections of the sinuses. Mechanism of
infections — their causes, symptoms and effect on health
Methods of examination and treatment.
VIII. (Class) Quiz on lecture, assisting with examination of the
nose and sinuses. Demonstration of nasal irrigation and nasal
spray. Control of nasal hemorrhages. Care of patient after
nasal operations. The preparation of patient and apparatus
for opening and irrigating the sinuses.
IX. (Lecture or clinic) The Observation of Early Symptoms and
Marked Abnormalitise
How to recognize early signs of eye, ear, nose and throat
trouble. Simple routine tests of vision and hearing for school
nurses. Examination of the mouth for adenoids, enlarged ton-
sils, and defective teeth. Assistance in dispensary treatment.
(This lesson should be held in the dispensary or children's clinic
and pupils should have an opportunity to observe cases them-
selves and try to identify the commoner abnormal conditions.)
X. (Lecture) Social Aspects of Diseases of the Eye, Ear, Nose and
Throat
Social importance of defects and diseases of the special
senses. Relation todefectiveness, dependency, unemployment,
etc. Social causes of blindness — industrial accidents, venereal
diseases, the midwife problem. etc. OrganizM troverr.cnt" for
NURSING IN MENTAL AND NERVOUS DISEASES 111
the prevention of blindness. Legislation, research and pub-
licity. Institutional care of the blind and deaf. Relation of
adenoids, tonsils and teeth defects to education and delin-
quency. Special applications to the work of the school nurse
and general public health work.
METHODS OP TEACHING
The clinical method should be used as much as possible. A
term of service in the out-patient department will usually pro-
vide good experience in this line of work. The general operat-
ing room training should precede the course.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Skeleton and separate head. Models of eye and ear. Charts.
All materials needed for practical demonstrations.
TEXT AND REFERENCE BOOKS
Emerson: Essentials of Medicine.
Bacon: Manual of Otology.
May: Diseases of the Eye.
Manhattan E. E. and T. Hosp. : Nursing in Diseases of the Eye,
Ear, Nose and Throat.
Pamphlets published by the New York State Committee for
the Prevention of Blindness.
See also under Anatomy and Physiology, Bacteriology and
Modern Social Problems.
Nursing in Mental and Nervous Diseases
TIME : 20 hours divided as follows :
Lectures and clinics by physician (neurologist or psychia-
trist), 10 hours.
Classes and demonstrations by nurse instructor with special
training, 9 hours.
Lecture on social aspects by head of social service department
or a specialist in mental hygiene, 1 hour.
Course to be given in early part of third year.
OBJECTS OF THE COURSE
1. To teach the student nurse the relationship between men-
tal and physical illness and the application of general nursing
principles to mental nursing.
2. To teach the underlying causes of mental disease with
modern methods of treatment available both in the hospital
and in the community, and to endeavor to overcome the stigma
attached to mental illness or mental hospital care.
3. To train the nurse in observation of symptoms as expressed
in early childhood and in later life through the behavior of
patients, so that the early signs of mental illness may be under-
112 OUTLINES OF SUBJECTS
stood and appreciated, and so that nurses may give active and
intelligent cooperation in movements for the prevention of
mental illness.
4. To teach the importance of directed habits of thought, de-
sirable associations and proper environmental conditions in
early childhood and to show the relationship of make-up to
mental disorders.
5. To assist in developing resourcefulness, versatility, adapt-
ability and individuality in the nurse. To emphasize quali-
ties essential to success in mental work and the importance of
special training in this branch of nursing.
OUTLINE OF LECTURES AND CLASSES
I. (Lecture) Introduction
Anatomy and physiology of the central nervous system.
Biological introduction. Sympathetic system and function.
II. (Class) Quiz' — Anatomy and physiology of the nervous system.
III. (Lecture) Neurology
Disorders of the cord: tumors, myelitis, poliomyelitis, tabes,
syringomyelia, sclerosis, atrophies, paralysis agitans, chorea,
tics, tetany.
IV. (Class) Summary of care of mental patients in hospitals with
present-day developments. The mental hygiene movement.
The admission of patients. Commitment procedures and pa-
role. Indications and contra-indications for restraint meth-
ods of treatment. Personal qualifications and educational re-
sources desirable for the nurse in mental work.
V. (Lecture) Neurological Conditions Associated with Abnormal
Mental States
Epilepsy, traumatic psychosis, brain tumor and brain ab-
scess, arterio-sclerosis of brain, aphasia, paralysis.
VI. (Class) General principles governing care of mental and nerv-
ous patients. The application of nursing procedures in neu-
rological conditions with special emphasis on care of skin and
the care of patients in convulsions. The effect of environment,
diet, exercise, massage, electric treatment, etc. The observa-
tion of symptoms as indicated in behavior. The necessity for
accurate record keeping of what actually occurs, not simply
impressions received. The importance of noting all physical
symptoms as well as mental.
VII. (Lecture) Organic Reaction Types
Senile dementia, dementia paralytica (general paralysis,
syphilis of nervous system). Cause, treatment, prognosis.
Laboratory aids to diagnosis.
VIII. (Class) Quiz on previous lecture. Nursing procedures in re-
tarded conditions, deteriorations, unconscious states, paralysis.
Importance of attention to bodily functions, diet, cleanliness,
prevention of bed sores, etc. Nursing measures in treatment
NURSING IN MENTAL AND NERVOUS DISEASES 113
by salvarsan or mercury. Methods of administering. Obser-
vation of symptoms.
IX. (Lecture) Delirium and Infectious Exhaustive States
States of intoxication. Alcoholic and drug psychosis. Hal-
lucinosis. Value of treatment by elimination — drugs, hydro-
therapy, etc.
X. (Class) Quiz on lecture. Nursing procedures in delirium and
exhaustion. Continuous tubs, packs, sponges. Various pre-
scribed treatments by eliminative, sedative or stimulating
drugs. Precautionary protective measures in administering
drugs and in giving treatments.
XI. (Lecture) States of Defect: Idiocy and Imbecility
Types of personalities. Constitutional inferiority and psy-
chopathic personalities. Psychopathology. Mental conflict
and perversions of adjustment and behavior.
XII. (Class) Quiz on lecture. Description of terms used in expres-
sion of mental states and conditions. Methods of dealing with
patient's questions. Observations necessary to gain the confi-
dence of patients. Disciplinary methods. The necessity for
a sympathetic understanding of human nature. Observation
of habits and tendencies to perversions. Preventive measures.
XIII. (Lecture) Dementia Praecox
Etiology, types, treatment.
XIV. (Class) Quiz on lecture. Observation of early symptoms —
habit deteriorations, etc. Re-educative measures. Thera-
peutic value of occupations and diversions. Tube feeding.
XV. (Lecture) Manic-Depressive Psychoses
XVI. (Class) Quiz. Management of resistive, combative, violent
and destructive patients. Precautionary measures against
homicide and suicide or injury. The furnishing of rooms of
wards for excited patients. The serving of meals. Observa-
tions to prevent accidents — care of keys, doors, locks, sharp
instruments, clothing, dishes, etc. Routine necessary for pro-
tection of patients. The value of hydriatic treatment and di-
version. The management and care of untidy patients.
XVII. (Lecture) Psychasthenia and Hysteria
Psychoneuroses. Minor psychoses.
XVIII. (Class) Quiz on lecture. General nursing procedures in func-
tional psychoses. Value of rest, isolation, diet, occupations,
hydrotherapy, diversions, re-education, environment, good
hygiene — mental and physical. Management of hysterical
convulsions. Value of packs and continuous tubs. Methods of
dealing with delusions and hallucinations.
XIX. (Lecture) Psychoanalysis in Diagnosis and Treatment
Means of obtaining data. Mental examinations. The value
of early hospital care. The nurse's influence in the community
as a means of furthering education and for the prevention of
mental disease.
114 OUTLINES OF SUBJECTS
XX. (Lecture) Social Aspects of Mental Disease
Economic and social conditions conducive to mental and nerv-
ous diseases, poverty, over-work, social vices, drugs and al-
cohol, isolation, etc. Relation of mental disorders and defects
to the family, to occupation, education, prostitution, crime and
lawlessness, etc. The burden on the community for the care
of mentally ill and defective. Measures for the prevention and
control of mental disease.
METHODS OF TEACHING
1. Few hospitals offer a special department in psychiatry, but
there is usually some clinical material in any general hospital,
which might well be used to illustrate the principles outlined
above. Some of these are the mental or nervous conditions
following or accompanying infectious diseases, toxemias, al-
coholism, advanced heart and kidney cases, carcinoma patients,
drug cases, and the various forms of hysteria and neurasthenia.
Where possible an affiliation should be arranged with a mental
hospital or psychiatric department, giving the pupils the op-
portunity for more continued observation and experience in this
very important branch of nursing.
2. As in other medical subjects the clinical method should be
used wherever possible, and every effort made to connect the
nursing, medical and social aspects of this class of diseases.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Charts and models, case notes, lantern slides and laboratory
specimens.
TEXT AXD REFERENCE BOOKS
Meyer and Kirby: Notes of Clinics in Psychopathology.
White: Outlines of Psychiatry.
White: Principles of Mental Hygiene.
Kraeplin: Clinical Psychiatry, Vol. III.
Barrus: Nursing the Insane.
Davenport: Heredity in Relation to Eugenics.
Richards: Euthenics "The Science of Controllable Environ-
ment."
Thorndike: Elements of Psychology.
Thorndike: Individuality.
James: Psychology.
Tiffany: Life of Dorothea Lynde Dix.
Dubois: The Education of Self.
Dubois: The Influence of the Mind on the Body.
Munsterberg: Psychotherapy
Hollander: Nervous Women.
Chapin: Compendium of Insanity.
Beers: The Mind that Found Itself.
See also references on Occupation Therapy, and Modern
Social Conditions.
NURSING IN OCCUPATIONAL, SKIN AND VENEREAL DISEASES 115
Nursing in Occupational, Skin, and Venereal Diseases
TIME: 10 hours, divided as follows:
Lectures and clinics by physicians (specialists) — 7 hours.
Classes and demonstrations by nurses (specially equipped in
these branches) — 2 hours.
Lecture by social service nurse — 1 hour.
OBJECTS OP COURSE
1. To make the pupil nurse familiar with the outstanding
features of the diseases in question, so that she may be able to
care for such cases, intelligently and skillfully and assist in
preventive work.
j. To help her to understand the social significance of these
diseases and to secure her interest and cooperation in remov-
ing the social and economic causes which contribute so largely
to their development.
OUTLINE OF LECTURES AND CLASSES
I and II. (Lectures) Occupational Diseases
Occupational factors in disease in general. Classification of
health hazards. Occupational diseases due to (a) gases, vapors
and high temperature, (b) conditions of atmospheric pressure,
(c) metallic poisons, dust and fumes, (d) organic and inorganic
dust and heated atmospheres, (e) fatigue. Special forms of
poisoning' — lead, phosphorus, arsenic, mercury, etc. Parasitic
diseases. Fatigue — its causes and effects. Occupation neu-
roses. Industrial accidents. Nursing care of occupational
diseases.
(For principles of Industrial Hygiene, see Public Sanitation.)
III. (Lecture) Venereal Diseases- — Syphiliis
History of syphilis. Earliest recorded appearance in Europe.
Discovery of germ and its characteristics. Clinical and lab-
oratory methods of diagnosis. Pathology of syphilis and gen-
eral characteristics of acquired syphilis. Primary stage from
venereal and non-venereal infection. Value of early diagnosis.
Secondary stage — clinical symptoms' — infectious and non-in-
fectious lesions. Tertiary stage — general symptoms and physi-
cal complications (mental, nerve, heart, etc.) Hereditary
syphilis' — evidences in infants, children and adults.
IV. (Lecture) Gonorrhea
History of gonorrhea. Characteristics of gonococcus. Clin-
ical and laboratory methods of diagnosis. Acute gonorrhea,
ophthalmia neonatorum and vaginitis in children. Symptoms,
treatment and complications. Manifestations in adults' — symp-
toms, treatment and complications. Mode of infection. Pre-
ventive measures. Chronic or recurring gonorrhea.
116 OUTLINES OF SUBJECTS
V. (Class and Demonstration) Quiz on preceding lecture. Nurs-
ing care of patients suffering from above diseases. Precautions
regarding infection. Preparation for Wassermann and Leuten
tests, administration of salvarsan (by intravenous, intraspinal,
and intramuscular methods), mercury injectibns and inunctions,
injection of silver salts and topical applications.
VI. (Lecture) Diseases of the Skin — Introduction
Review structure and function of the skin and accessory or-
gans. Relation to nerve supply and temperature control. The
hygienifc care of the skin. Pathology of skin diseases. Inflam-
matory changes of pigment and the causes of growths. Classi-
fication of skin lesions. Assign cases for observation and re-
port.
VII. (Lecture) Lesions of the Skin
Review bacteriology of skin diseases. Types of lesions in
akin proper and in mucous membranes. Symptomfe — general
and local. Characteristic rashes. Complications, treatment
and general precautions. Board of Health Regulations.
VIII. (Lecture) Common Skin Diseases
Occurrence, causes, symptoms, treatment, and prophylaxis of
anaemia of the skin, hyperemia, erythema, eczema, herpes,
urticaria, dermatitis, impetigo, psoriasis, erysipelas and para-
sitic diseases of the skin.
IX. (Class) Quiz on three preceding lectures. Nursing measures
in skin diseases with special reference to hygiene, diet, bathing,
local applications and dressings, etc. Starch and alkaline
baths. Preparation for X-ray treatments.
X. (Lecture) Social Aspects of Skin and Venereal Diseases
Relation of housing, living conditions, social habits, immi-
gration, etc., to skin diseases. Relation to occupation and to
social intercourse (as in schools, clubs, etc.) Relation of ve-
nereal disease to prostitution, blindness, illegitimacy, infant
mortality, insanity, crime and other social problems. Public
Health aspects of the problem. Legislation and publicity
methods. Reporting of cases of venereal diseases. The men-
ace of charlatans and secret remedies. The function of the free
and pay clinic.
(For social and economic aspects of occupational disease and
for educational problems connected with sex-hygiene see under
Modern Social Conditions.)
METHODS OF TEACHING
1. Use the clinical method wherever possible. Have pupil
study case records and observe typical cases in wards and out-
patients department between classes. Dispensary experience
is especially valuable in connection with this course.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
Bacteriological slides and cultures, charts and models, pub-
licity literature and exhibits.
OPERATING ROOM TECHNIC 117
TEXT AND REFERENCE BOOKS
Oliver: Diseases of Occupation.
Thompson: Occupational Diseases.
Goldmark: Fatigue and Efficiency.
Dock: Hygiene and Morality.
Morrow: Social Diseases and Marriage.
Stelwagon: Diseases of the Skin.
Jackson: Diseases of the Skin.
Meachen: Diseases of the Skin for Nurses.
Publications of Society of Moral and Sanitary Prophylaxis
(N. Y.). American Social Hygiene Association and State
Departments of Health — (See Oregon and other state and
local publications).
Operating Room Technic
TIME: 10 hours. Classes and demonstrations I to VIII conducted by the
operating-room nurse. Lectures IX and X by a physician or
trained anesthetist. Course given in the second year.
OBJECTS OF THE COURSE
1. To give the pupil nurse a good scientific basis for the
surgical technic of the operating room, to introduce her to the
various methods and procedures in use in all forms of operative
work, whether in the hospital or outside, and to help in develop-
ing the "aseptic conscience."
2. To make the pupil familiar with the equipment of the op-
erating-room, its cost, use, and care, and to help her in the
preparation of standard supplies.
3. To give her a general idea of the use and action of anes-
thetics, so that she may be able to care for the patient and assist
the anesthetist more intelligently, and if necessary administer
an anesthetic in an emergency, under a surgeon's direction.
NOTE. It is not the intention here to have the pupil special-
ize in either operating-room work or anesthetics. This would
require a 1'dnger preparation and should be deferred till after
graduation.
OUTLINE OF CLASSES
I. The Operating Room and its Equipment
The relation of this department to others in the hospital.
Structure, finishings, and furnishings of the operating-room
and suite. Temperature and moisture of air. Light. Care
and cleaning of the room and equipment. Manipulation of
tables, etc. The operating-room staff, its duties and responsi-
bilities. Special need for intelligence, concentration, and
trustworthiness on part of operating-room nurses. Organiza-
tion of the daily service. Surgical nomenclature.
118 OUTLINES OF SUBJECTS
II. The Sterilizing Room
Review of surgical bacteriology and principles of sterilization.
Construction, operation, and care of autoclave and sterilizers.
Fractional and single sterilization. Disinfectant solutions in
the operating-room. Their preparation and use. Sterilization
of utensils, pitchers, basins, etc.
III. Instrument and Supply Room
Names of instruments. Care, cleaning, and sterilization.
Drugs and solutions, kinds, preparations, and sterilization.
Storage and care of splints, sandbags, and mechanical appli-
ances. Care of actual cautery and special apparatus.
IV. Preparation of Dressings and Supplies
Preparation and sterilization of gauze dressings, pads, pack-
ings, drains, bandages, needles, sutures, ligatures, and linen
supplies (gowns, masks, sheets, swathes, etc.) Storing and as-
sembling supplies.
V and VI. The Operation
Essentials of aseptic technic. Results of broken technic.
Necessity for good team work in securing speed and efficiency.
Fitting up the operating-room. Preparation of surgeon and
nurse. Preparation of the patient. Positions on the table,
support and draping. Preparation of the site of operation.
Operative steps. The sponge count. Emergency measures, in-
fusions, transfusions, etc. Duties of each member of the oper-
ating and assisting staffs. Removing patient from the table.
After care and clearing away. Care of pathological specimens.
VII. Modifications of Technic for Special Types of Operation
Selection of instruments, dressings, sutures, etc., for opera-
tion on head, neck, liver and gall bladder, kidney, vagina, etc.
Also for fractures, orthopedic cases, minor operations and
septic cases.
VIII. The Emergency Operating-Room
Equipment of the emergency operating-room. Emergency
technic. Minimum requirements. Typical emergencies as a
result of mine disasters, train wrecks, etc., and their handling,
with and without standard equipment. Night operations. Ar-
rangements of light and other special adjustments.
IX and X. Anesthetics
History of anesthesia. Types of anesthetics, local, spinal,
and general, and their uses. Types of inhalers. The equip-
ment of the anesthetic room. The anesthetic table and stimu-
lating tray. Oxygen apparatus. Nurse's care of the patient
before, during, and after the anesthetic. Principles to be ob-
served in the administration of the commoner anesthetics.
The preliminary steps. Unfavorable symptoms. Accidents.
After-effects. Mental influences in relation to anesthesia.
Technic of anoci-association.
EMERGENCY NURSING AND FIRST AID 119
METHOD OP TEACHING
1. The classes should be held in the operating-room where
pupils can see and hatodle the equipment and where demonstra-
tions can be set up by the instructor and the pupils. Observa-
tion of one or two operations would help to illustrate the main
principles and methods.
2. If it is possible it would be better to give this course to
smaller groups, taking those who have just begun their operat-
ing-room training or who are soon to begin i4;. The class and
practical work would then supplement and reinforce each other.
If it is impossible to give ftine for regular organized class
work, the subject should be covered through individual instruc-
tion and demonstration with supplementary readings in good
reference books.
3. Quizzes should be given frequently, and drills on essen-
tial points. Students should not be required to memorize
lists of instruments and supplies but should if possible have
typewritten sheets giving typical layouts, which can be re-
ferred to when needed.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
The equipment of the operating-room. Catalogues of sup-
ply houses giving names and prices of instruments, furniture,
utensils, etc. Skeleton, charts, etc., as required.
TEXT AND REFERENCE BOOKS
Parker and Breckinridge : Surgical and Gynecological Nursing.
Howell: Surgical Nursing and Hospital Technic.
Robb: Aseptic Surgical Technic.
Senn: Opera ting-Room Technic.
Fowler: The Operating-Room and the Patient.
Smith: The Operating Room.
Emergency Nursing and First Aid
TIME: 10 hours. Classes and demonstrations conducted by the nurse
instructor, or by a physician and nurse who are especially com-
petent to handle this subject. To be given in the latter part
of the senior year.
OBJECTS OP THE COURSE
1. This short course is intended to help the nurse to adapt
her hospital methods a little more readily to the situations
which she will meet on graduation, especially to emergency
conditions such as may be met in army work, in accidents of
various kinds, and in pioneer service where equipment and
facilities are limited.
2. Such a course will also serve as a review of practical nurs-
ing principles and procedures for students who intend to take
120 OUTLINES OF SUBJECTS
the state examinations. Quick thinking, adaptability, re-
sourcefulness, economy and speed, would be emphasized as well
as careful technic.
3. The demand for classes in elementary nursing and first
aid to be given to clubs and groups of various types is increas-
ing so rapidly that nurses should be prepared to assist in such
teaching and should thus be in touch with the latest and most
approved methods in emergency work.
OUTLIVE OF CLASSES AND DEMONSTRATIONS
I. Introduction
General principles and scope of first-aid work. Qualities
demanded and dangers to be avoided. Materials required.
First-aid outfits of various types. Improvised outfits. Or-
ganization of nursing service in case of fires, railway accidents
and other public disasters. Organization for service in time
of war.
II and III. Transportation of the Injured
General principles to be observed in transportation. Ve-
hicles available. Ambulances. Improvised vehicles. Stretch-
ers'— manufactured and improvised. Loading and carrying
stretchers, carrying over obstructions, up and down stairs, etc.
Carrying patients in a chair, hammock or blanket-sling. Car-
rying pick-a-back and in arms. The fireman's lift. The two,
three and four-handed seat. Special methods of transportation
in fires, in case of flood, etc. Stretcher drill.
IV and V. Surgical Emergencies
Essentials of surgical first-aid. Emergency dressings and
methods of sterilization and disinfection. Improvised splints,
padding and bandages for use in fractures, dislocations, sprains,
etc. Improvised tourniquets. First-aid treatment of frac-
tures, wounds, burns, bruises, frost-bites, etc., of various
types. Treatment of hemorrhage.
VI and VII. Medical Emergencies
States of unconsciousness. Various causes and how to dis-
tinguish commoner conditions. First-aid treatment of fainting,
shock, apoplexy, intoxication, convulsions (of commoner types),
sun-stroke, heat exhaustion, electrical shock, drowning, chok-
ing, gas and drug poisoning.
VIII. Adaptation of Nursing Measures
Surroundings, conditions and facilities usually found in city
tenements, in country districts, in military camps, mining dis-
tricts, etc. Essentials of sick-room sanitation and personal
care under any of these conditions. Modification of treatments
to be worked out on basis of resources available.
IX and X. (Two-hour period) Demonstration of Nursing Measures
The following problems are suggested: — Putting up a croup-
tent in a city tenement; making a camp bed; giving a slush
SPECIAL DISEASE PROBLEMS 121
bath in a camp bed; giving a hot pack in a camp or country
house; preparing for an obstetrical case in a private house;
preparing for an operation in a private house or camp; care of
shock under emergency conditions, etc.
METHODS OF TEACHING
1. Since most of the principles covered in this course should
be familiar to senior nurses, the main effort will be to have
them work out the applications as a test of their understanding
and resourcefulness. Problems should be assigned ahead of
time and each individual should be responsible for some part of
the discussion and demonstration.
2. It is suggested that the demonstrations be made before
the school and the pupils rated on the points most essential in
first-aid work.
3. An excellent way of developing interest in such a course
is to have the pupils assist in giving classes to a small group
of factory girls, boy or girl scouts or camp-fire girls. Great
care should be taken, however, that the work should be very
elementary in character and thoroughly taught.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
1. Beds, bedding, utensils, furnishings and surgical materials
as for other nursing classes, with a variety of common house-
hold and out-door materials to be used for improvising equip-
ment.
2. First-aid outfits for use in factories, mine accidents,
schools and households, army kit, Red Cross kit, outfit for
automobile trips, etc.
3. First-aid charts (Red Cross and other kinds).
TEXT AND REFERENCE BOOKS
Morrow: Immediate Care of the Injured.
Lynch: Red Cross Text-book on First-aid and Relief Columns.
Wharton : Minor Surgery and Bandaging.
Doty: Prompt Aid to the Injured.
Eliason: First Aid in Emergencies.
See also text-books in Nursing, Medicine and Surgery.
Special Disease Problems (Elective)
TIME: 10 hours. Conferences, case studies and written reports. Con-
ducted by experts in different subjects studied.
OBJECTS OF COURSE
1. The idea is to give each senior student an opportunity of
making a more extended study of some method of treatment
or some one disease or class of diseases, taking the case as the
122 OUTLINES OF SUBJECTS
unit of study, and coordinating all the various aspects (pathol-
ogy, therapeutics, nursing, etc.) previously studied as separate
subjects.
2. To test out their ability to work out an independent
problem as they will have to do when they leave the hospital,
to consult sources and gather material for themselves and to
organize the results of their observation and inquiry in the
form of a report or case history, such as might be published
in a nursing journal.
3. To study any new or special forms of disease or treatment
which may have been slighted or overlooked in the previous
courses.
SUGGESTED PROBLEMS
These would vary widely, according to the special interest of
the student, and the material at hand. Problems along the
following lines might be suggested:
I. Newer methods of treatment in pneumonia, infantile
paralysis, typhoid or any otjier disease.
II. Devices for improving nursing technic and increasing
efficiency in nursing procedures.
III. Special dietary studies.
IV. Special forms of therapeutics.
V. Nursing treatment of rare or unusual cases.
VI. Study of a hospital epidemic.
VIII. Special features in any branch of nursing — obstetrical,
children's, mental and nervous, etc.
IX. Study of certain symptoms or phases of disease such as
shock, post-operative vomiting, chill, crises, symptoms of ap-
proaching death, sleeplessness, delirium, etc.
METHODS OF TEACHING
1. A great deal of this work would have to be individual.
General direction and advice could be given by the best quali-
fied person available, but the student must do the greatest
part of the work herself.
2. A few conferences of the class would be held to present
reports of the work being done, so that each student would
profit by the results of the others' work.
3. These should be supplemented by lectures by specialists
on any new or interesting subjects connected with the study and
treatment of disease.
TEXT AND REFERENCE BOOKS
See under preceding subjects.
F. SOCIAL AND PROFESSIONAL SUBJECTS
History of Nursing (including Ethical and Social Principles)
TIME: 15 hours, divided as follows:
Classes I to X conducted by the superintendent of nurses or
instructor — 10 hours.
Classes XI to XV given by the social service worker or visit-
ing nurse — 5 hours. This course to be given in the early part
of the preparatory year.
OBJECTS OF COURSE
1. To arouse interest and enthusiasm in nursing as an occu-
pation, by introducing the pupil nurse early to the long and
splendid history of nursing, and the great leaders who have
established its traditions and ideals.
2. To make them appreciate some of the obstacles that have
been overcome in making the profession what it is, sind some
of the opportunities which are open to them in the future.
3. To explain the origin and meaning of hospital regulations
and hospital etiquette, and to secure the cooperation of the
pupil nurse in carrying out the purposes of the hospital har-
moniously and effectively.
4. To interest the pupil from the beginning in the social as
well as the medical aspects of her work and give her some
realization of the social and economic conditions which bring
patients to the hospital and complicate recovery.
5. To encourage in the pupil a sympathetic attitude toward
her patients as people, a better understanding of their prob-
lems and the conditions under which they live, and to make
her more ready and able to cooperate with the social service
department and other agencies in helping them.,
OUTLINE OF CLASSES
I to X. History of Nursing- — including ethical principles
I. Introduction:
Brief discussion on the meaning of nursing, the present de-
mands in hospital work, and the ideals which pupils bring to
their new task. Reasons for the study of nursing history — to
understand and appreciate nursing traditions and ideals, to
study the stages of development through which nursing has
passed, to note the people and influences which hare helped
to make the profession what it is and to find out the origin of
common observances and customs. Explanation of the pur-
pose of training and those features of hospital life which are of
immediate importance to new pupils. A very brief outline of
the main periods in general history reviewed as a basis for
nursing history.
123
124 OUTLINES OF SUBJECTS
II. The Origin and Early Development of Nursing
Original meaning of nursing — "to nourish." Maternal or
parental instinct, the root of the nursing impulse shown in
protection, nourishment, care and fondling of young. Nurs-
ing and first-aid among animals. Rudiments of nursing care
among primitive peoples. Influence of religious beliefs and
ceremonials on the care of the sick. Early rites of hospitality
— their relation to ancient institutions for the care of sick
strangers. Gradual development in standards of humanity
and justice. Beginning of public relief for sick and unfortu-
nate. General standards of hygiene, sanitation, therapeutics,
nursing and medical science in ancient civilizations. Hippoc-
rates'— the "Father" of medicine — influence on medicine and
nursing. Ethical ideals as shown in the Hippocratic Oath.
Countries where nursing is still in the primitive stage of de-
velopment.
III. Influence of Christianity on Nursing. The Ascetic or Saintly
Ideal
Influence of Christian ideas of brotherhood, pity, charity
and self-sacrificing service seen in the work of the deacons
and deaconnesses of the early church — first organized nursing
service. Relief of sick and unfortunate gradually taken over
by the church. Hospitals established as religious and char-
itable institutions. Nursing advocated as a form of religious
discipline and service. Paula, Marcella and Fabiola — types
of nursing leaders of this period. Growth of monastic institu-
tions and tendency toward seclusion from the world and the
contemplative life rather than the active ife of service.
Emphasis on ascetic practices' — penance, self-mortification and
self-abnegation. Monasteries as centres of relief and hospi-
tality. Nursing and medical work of monks and nuns. Influ-
ence of prevalent superstititions, and belief in magic and
miracle on the care of the sick. Radegunde and Hildegard,
types of monastic women.
IV. Aristocratic and Military Influences. The Romantic or Knightly
Ideal
Rise of the institution of chivalry with new ideal of the
Christian knight, defender of the weak and helpless and re-
dressor of human wrongs. Life of struggle, adventure and
romance opposed to the repressed, sheltered, contemplative
life of the cloister. Virtues of the warrior-knight, robust,
active and positive — courage, hardihood, honor, courtesy,
loyalty, leadership, etc. Combination of chivalric and monas-
tic ideals in military nursing orders developed during the cru-
sades. Hospital expansion under the knightly orders. Intro-
duction of aristocratic and military features in hospital organi-
zation and management. Knights of St. John as types of
Hospitallers. Influence of knightly and military ideals on
later hospital nursing. Red Cross and army work.
HISTORY OF NURSING 125
V. Democratic and Secular Tendencies in Mediaeval Nursing
Rise of the mendicant order under Saint Francis of Assisi
as a reaction against extreme forms of monasticism and aris-
tocratic tendencies of military orders. Friars — a democratic
organization bringing spirit of brotherhood and ideals of prac-
tical religion into every day life. Nursing one of many forms
of active social service undertaken by mendicants, illustrated
by St. Francis' work among the lepers. Founding of secular
and semi-secular orders for nursing and relief opened avenues
of service to people in common walks of life and led to higher
ideals of citizenship. Extreme restrictions and ascetic dis-
cipline of monastic orders no longer considered essential to
nursing and charitable work. The Tertiaries of St. Francis,
and the Beguines, types of voluntary secular orders organized
on a religious basis. St. Catherine of Siena and St. Elizabeth
of Hungary types of non-monastic nursing saints and popular
heroines of mediaeval times. Cities and communities begin-
ning to undertake some responsibility for 'relief and care of sick
and unfortunate and prevention of poverty and distress. Re-
vival of interest in medicine after a long period of indifference
and neglect, and study of medicine in the early universities.
VI. The Dark Period in Nursing
Decline in many of the religious orders and general dete-
rioration in hospital and nursing work. Suppression of many
orders. Hospitals gradually taken over by civil authorities.
Servant nurses generally employed for the care of the sick both
in religious and civil hospitals. "Sairey Gamp"- — type of the
ignorant, secular, servant nurse or "monthly nurse." Low
ideals of honesty, personal morality, dignity and humanity.
Standards of hospital service very low. Amateur "Lady
Bountiful" type of nursing and charitable work in parish and
country districts. Work of missionary nurses in Canada com-
pared with servant nurses and religious orders at home.
Countries where nursing is at present largely in the hands of
servant nurses and amateurs.
VII. Humanitarian Movements of the Early Modern Period
Beginnings of organized charity in France (17th C) under
leadership of Vincent de Paul. Sisters of Charity — new type
of nursing and relief organization. Reforms in care of pris-
oners, insane and sick in hospitals, stimulated by work of
John Howard, Elizabeth Fry, William Tuke, Dr. Pinel and
other humanitarian leaders. Revival of deaconess work by
the Fliedners of Kaiserworth. Humanitarian and religious
ideals combined in these newer nursing organizations, with
beginnings of definite standards of nursing work and training.
Gradual advance in medicine as a result of discoveries of Har-
vey and other scientists. Revival of surgery through barber
surgeons, Pare" and others.
126 OUTLINES OF SUBJECTS
VIII. Modern Nursing Established by Florence Nightingale
Story of Florence Nightingale's life and work. Her new
conception of nursing as an economically independent secular
vocation or art demanding intelligence, knowledge and skill,
as well as devotion and moral purpose. The necessity of long
and careful training emphasized and the first schools of nurs-
ing established. Ideals of nursing as shown by Florence
Nightingale's example and teachings. Influence of the growing
freedom and independence of women on nursing work.
IX. Recent Developments in Nursing
Scientific advances of the 19th C in medicine, surgery, sani-
tation, anesthetics, etc., due to the work of Pasteur, Lister,
Morton and others. Social and philanthropic movements a<
seen in the work of Dorothea Dix, Octavia Hill, etc. Founding
of the Red Cross. Work of Dunant, Clara Barton and others.
Educational advancements, especially in the education of
women. The influence of all these movements on nursing.
Founding of first nursing schools in America. Pioneer leaders
in nursing education. Founding of nursing organizations.
Modern expansion of the field of nursing.
X. Modern Professional Ideals and Standards
Evidences of religious, ascetic, military, democratic and
humanitarian ideals in nursing of the present day. Status of
nursing in principal countries of the world. What it means to
be a member of a profession. Application of nursing ideals and
spirit to practical problems of hospital life. Origin and mean-
ing of hospital etiquette, hospital discipline, the uniform, etc.
Responsibility of nurses in maintaining the great traditions of
nursing.
Periods XI to XV. Social Aspects of Nursing and Hospital Work
XI. Relation of Nursing and Hospital Work to Community and
Family Welfare
Brief survey of nursing history to show the identification of
nursing with all forms of social and philanthropic work in the
past. Nursing still essentially a form of social work. The
hospital also essentially a social institution bound up inti-
mately with family and community welfare. Meaning of com-
munity or social welfare. Recent changes in the conception of
all charitable and philanthropic work. New emphasis on pre-
ventive and constructive measures. Definition of "society" —
"social." Elements for which adequate provision must be
made in a normal or healthy community — health, education,
employment, recreation, moral and spiritual life. Importance
of the family in community life. Biological and social func-
tions of the family. Training for citizenship and life in larger
social groups. Deficiencies in institutional typo of upbringing.
General effects of family disorganization and disintegration.
Efforts to conserve the family and promote its influence and
wolf are.
HISTORY OF NURSING 127
XII. Some Social Problems as Seen in the Hospital
Types of patients seen in the wards and dispensary who rep-
resent social problems of various kinds — drug habitues, pros-
titutes, unmarried mothers, tramps and rounders, dependents,
alcoholics, patients with venereal diseases, patients with other
communicable diseases, foreigners, victims of industrial dis-
eases and accidents, etc. Social causes operating to bring
these people to the hospital — ignorance, poverty, lack of sani-
tation and sanitary control on part of community, bad in-
dustrial conditions, etc. In case of foreigners all of above
combined with exploitation and lack of adaptation to American
conditions. What the social service department tries to do for
these people.
XIII. How Adverse Social and Economic Conditions Operate in Child-
hood
In infancy bad heredity due to alcoholism, mental defect,
degeneracy of parents, etc., insufficient care of mother before
and after childbirth and of child at birth and during early
period, inability of mother to nurse child, impure milk, bad
sanitary surroundings, mother's ignorance, etc. In childhood
— lack of care, due to ignorance, poverty, resulting in malnu-
trition and bad environment, bad housing, etc. Effects of
communicable diseases of childhood, physical defects, child
labor, bad sanitary conditions at school and lack of medical
inspection and nursing. (Specific examples of these condi-
. tions.)
XIV. How Adverse Social and Economic Conditions Operate in Adult
Life
Effects of poverty and insufficient wages, communicable dis-
eases (especially tuberculosis), bad housing, overcrowding,
unemployment, bad working conditions resulting in industrial
diseases and accidents, insufficient opportunity for recreation,
etc. Special difficulties in the case of immigrant families.
Problems of mental defectives.
XV. Local Social and Economic Conditions
Make a broad general survey of the community or section
of the city in which the hospital is located, noting its history,
population (number, characteristics, nationalities, etc.),
health activities (state and local milk supply, institutions
for the sick, preventive work, housing); industries (kinds,
legal regulations, dangerous occupations, etc.), opportunities
for recreation; social institutions (churches, schools, settle-
ments, clubs, etc.). Show how the character of the community
and its problems affect the work done in the hospital and how
the hospital affects the community. Show how pupil nurses
can assist in making the hospital work most effective socially
as well as medically.
128 OUTLINES OF SUBJECTS
METHOD OF TEACHING
1. In such a short course it is impossible and unnecessary to-
take up many detailed historical facts. If the pupils get a
good general picture of the progress of nursing and the inter-
esting personalities and events which have helped to mould
it, if they catch the spirit of the great leaders, and their inter-
est is aroused in the literature of nursing, the greatest result
will have been achieved. The class and discussion method is
to be preferred to the lecture for most of this course.
2. It is essential that some view of the general historical
background should be given before taking up the nursing his-
tory. A rough tabulated chart of the chief historical epochs
and events of European history according to centuries will
help to place the general scheme before the pupil's mind and
will enable her to correlate her nursing and general history
better.
3. Every means should be taken to make the events and the
personalities vivid and concrete. Pictures are invaluable
and fortunately there are many excellent ones available. A
collection of historical books adds greatly to the interest.
4. In the social topics the first effort should be to arouse in-
terest in people rather than in abstract principles and prob-
lems. Specific cases should be studied as types' — preferably
patients the pupils have met in the wards or out-patients de-
partment. Only the essential elements in each case should be
pointed out and anything like a mere curious or sentimental
interest should be discouraged. Hopelessly tragic cases
should not be selected, and the opportunities and methods of
helpful constructive work along very simple lines should be
suggested. There should be no attempt to teach methods of
social work at this stage — but pupils can be assigned to help in
running messages, amusing children, dressing and undressing
them, etc., so getting an insight into the problems of the dis-
pensary.
5. In addition to selected readings and class reports, the
pupils should visit some of the social institutions and agen-
cies in the community, and each individual should accompany
the social service worker or visiting nurse in her home visits
for a few afternoons to get a good picture of home conditions.
ILLUSTRATIVE MATERIAL
Photographs of pictures illustrating care of the sick in an-
cient and modern times, nursing saints, medical and nursing
leaders, historic institutions, etc. Pictures, exhibits and
charts illustrating social conditions and the work of social
agencies. Bulletins and pamphlets published by various social
organizations.
HISTORY OP NURSING 129
TEXT AND REFERENCE BOOKS
I. History of Nursing
History of Nursing: Nutting and Dock, 4 vols.
Cooke : Life of Florence Nightingale, 2 vols.
Tooley: History of Nursing in the British Empire.
Robinson and Breasted: Outlines of European History.
Berdoe: Origin and Growth of the Healing Art.
Withington: Medical History from the Earliest Times.
Tuker and Malleson: Handbook to Christian and Ecclesiasti-
cal Rome.
Putnam: The Lady.
Mozans: Women in Science.
Loch: Charity and Social Life.
Saleeby: Surgery and Society.
Richards: Reminiscences of Linda Richards.
Tiffany : Life of Dorothea Dix.
Dickens: Martin Chuzzlewitt.
Epler: Life of Clara Barton.
Boardman: Under the Red Cross Flag.
Articles in Encyclopedia Britannica under Medicine, Monas-
ticism, Chivalry, Church History, Mendicant Orders, St.
Francis, etc.
Paget: Confessio Medici.
Richer: L'Art et la Medicene.
Lacroix: Military and Religious Life of the Middle Ages.
Mullerheim : Die wochenstube in der Kunst.
(The last three especially interesting for their illustrations.)
(See also under Nursing Ethics, Professional Problems, etc.)
II. Social Aspects of Nursing
Wald: The House on Henry Street.
Hunter: Poverty (especially chapters I and IV).
Devine: Misery and Its Causes (especially chapters I and II).
Devine: The Normal Life.
Reports of the Federal Children's Bureau (especially Infant
Mortality Series, no. 3, Johnstown Report).
Kelley: Modern Industry (especially chapters I and II).
Elwood: Sociology and Modern Social Problems — Chap. IV-
VIII inclusive.
Addams: Twenty Years in Hull House.
Addams: The Spirit of Youth and the City Streets.
Addams: Democracy and Social Ethics.
Commons : Races and Immigrant in America.
Steiner: On the Trail of the Immigrant.
Osier: An Alabama Student and Other Essays.
Ross: Social Psychology.
Lee: Social work with Families and Individuals, published by
the New York School of Philanthropy and other pamphlets.
Byington: What Social Workers should know about their own
130 OUTLINES OF SUBJECTS
Communities (Pamphlet published by Russell Sage Foun-
dation, New York).
The Survey: (Journal of Social Work).
Elements of Psychology
TIME: 10 hours. Lectures and class discussions. Taught by a psy-
chologist or a qualified nurse or social worker. Given in the
latter part of the first year.
OBJECTS OF COURSE
1. To attempt to state the fundamental principles underly-
ing human conduct.
2. To give the student practice in considering people's ac-
tions with impersonal understanding and sympathy.
3. To develop certain principles for dealing wisely with pa-
tients and others in professional relations.
4. To help the student toward self-mastery and good sense
in the relationships of private life.
5. To provide a basis for subsequent courses in psychiatry
or ethics.
OUTLINE OF CLASSES
I. Psychology the Science of Behavior
Behavior considered as responses to "stimuli." People con-
sidered as organisms adjusting to changing environment, nat-
ural and social, by acting upon the environment. Behavior
such adjustment.
II. Adjustment made by the Nervous System
Its structure — brain, cord, fibres, sympathetic system;
neurones. Functions. Nervous pathways Readiness.
III. Pathways Due to Original Nature
Reflexes. Instincts, their nature. Typical instincts. Read-
iness and the original satisfiers. Modifying instincts.
IV. Individual Differences in Behavior
Central tendencies — the "curve of distribution." Causes of
differences. Heredity— race and family, variations. Age, sex,
and past experience.
V. Effect of Past Experience on Behavior
Learning. Habits. The "laws of learning." Practice.
Specific nature of habits.
VI. Variety of Responses to Same Stimulus
Influence of accompanying circumstances. "Mind set,"
mood, temperament. Influence of weather, health, fatigue,
drugs, emotional state, purpose, etc., on responses.
VII. Thinking
Physiological basis. Attention and interest. Memorizing.
Association and analysis. Studying, "appcrceptive mass."
Reasoning.
PRINCIPLES OF ETHICS 131
VIII. Feeling
Pleasantness. "Satisfiers and annoyers." Associative
shifts of satisfaction. Emotions, their dependence on organic
action. Control and use of feeling.
IX. Doing
Will and habit. Selection and attention in willing. Individ-
ual differences in will. Morality, social basis, psychological
elements. "Character."
X. Suggestion
. Presenting the stimulus that calls forth the desired act. Tact.
Use of principles already discussed. Understanding people.
Self-mastery.
METHODS OF TEACHING
Class discussion based on simple text-book if possible. Lec-
ture on points for which text-book is not available. Reference
reading. Written and oral reports of actual experiences, and
questions from pupils relating to individual problems.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Anatomical charts and models of brain and nervous system.
REFERENCE BOOKS
Thorndike: Elements of Psychology.
Thorndike: Educational Psychology. (Briefer course, — 1914.)
Thorndike : Individuality.
Colvin and Bagley: Human Behavior.
James: Psychology. (Briefer course.)
James: Talks to Teachers on Psychology.
Pillsbury: Essentials of Psychology.
Miller: Psychology of Thinking.
Ribot: Diseases of the Personality.
Ribot: Diseases of the Will.
Kirkpatrick: Fundamentals of Child Study.
Tyler: Growth and Education.
Principles of Ethics
TIME: 10 hours. Classes and conferences conducted by the superinten-
dent of nurses or a special lecturer. Given in the second
year.
OBJECTS OF THE COURSE
1. To follow up the work of the first year in the historical
and social aspects of nursing by a fuller discussion of the prin-
ciples of behavior, their origin, meaning and practical bear-
ings on the common experiences and problems of life.
2. To try to lead the pupil to formulate more clearly and defi-
nitely her philosophy of life, to stimulate her in the formation
of the right kind of personal habits, to help her in building up
132 OUTLINES OF SUBJECTS
a strong and an attractive personality, and to give her a vision
of what a full, happy, useful, and well-ordered life may be.
3. The effort is made here to build up broad general principles
which apply equally well to all phases of life and all types of
people, rather than to emphasize a special code which is re-
stricted to one group and one type of occupation.
OUTLINE OF CLASSES
I. Introduction — Customary Morality
Meaning and derivation of ethics, morals, customs. Dis-
tinguish from etiquette, manners, religion. Kind of pjoblems
considered in a study of ethics (give concrete examples) <YT3asis
of all behavior found in the original nature of man with its
equipment of instincts ( and tendencies,' These neither good
nor bad in themselves, but become good or bad according to
their effect on other human beings. Repetition and resulting
satisfaction the conditions of development. Four levels of
stages of conduct: (1) Instincts, controlled and influenced
only by physical pains and pleasures; (2) modified by rewards
and punishments; (3) controlled by the thought of praise or
blame; (4) Conduct regulated by a personal ideal which enables
one to do right even when it entails personal suffering and the
condemnation of society. First stage non-moral, represented
by infants and mental defectives. Most people in second and
third st&ges' — where custom and tradition are principal guides
to conduct (group or customary morality). Customs and laws
gradually built up by the social group for its own welfare and
protection, and habits enforced through ritual and ceremony,
force of public opinion or physical force. Weakness and lim-
itations in this kind of morality.
II. Personal or Reflective Morality
Personal as opposed to group or customary morality involves
free choice and independent moral judgment, instead of un-
reasoning acceptance of custom and slavish imitation of others.
Social habits and customs still determine conduct to a large
extent but the individual is responsible and accountable for his
own actions. His conduct becomes purposeful, voluntary, and
spontaneous, as opposed to impulsive or forced conduct. Laws
which he first obeyed mechanically, he learns to obey ration-
ally. In this stage of conduct, morals are differentiated from
manners, conscience substituted for custom, and principles
for rules of conduct. ' Personal or reflective morality has three
aspects: (1) right feeling or a delicate sensitiveness to ethical
ideals and an ardent desire to realize them; (2) right thinking
or sound moral judgment; (3) right doing or the vigorous carry-
ing out of one's purposes and ideals. This is conscientiousness
or obedience to the inward law "where the person himself
sets up the ideal standard, judges his conduct by it, holds him-
PRINCIPLES OF ETHICS 133
self responsible to himself and seeks to do justice." Con-
science is not infallible — needs constant enlightenment and
training, must be kept sensitive and responsive, and must be
obeyed as the highest moral law which the individual knows.
III. Ethical Ideals and Standards
Ethical ideals are the product of all the preceding ages and
of all one's experiences in life. The body of accepted moral
and ethical principles have very slowly accumulated and are
constantly undergoing changes and modifications. Each age
works out a different conception of moral worth or goodness.
Great moral leaders are those who break through traditions and
customs, and establish new ideals of conduct. They are the
prophets, saints, martyrs, and reformers. Moral ideals are
embodied in art, literature, religion, law, etc. Earliest ethical
principles of high value found in Hebrew and Greek literatures.
The Roman law and the Christian Church, the main sources
of later ethical standards and the great conservative forces in
preserving old standards. Examples of early ethical teachings
seen in the ten commandments, the golden rule, proverbs,
fables, etc. Ethical influence of great characters in history,
biography, fiction, and contemporary life.
IV. Moral Judgment
The second essential to reflective morality, is sound moral
judgment or wisdom, "the parent or nurse of all the virtues."
Element of choice and moral valuation implies capacity for
reflection, discrimination and sound thinking as well as an
adequate body of knowledge to guide one's decision. Imagi-
nation needed to forecast possible results of any given choice
and to see the wider and more remote as well as the immedi-
ate results. Sympathetic insight into others' lives and a wide
acquaintance with human nature necessary to insure just judg-
ments. Wisdom needed in deciding means to be used as well
as ends to be realized. Wisdom means insight, sagacity, san-
ity, and common sense; not to be confused with mere knowl-
edge. Moral judgment not essentially different from judgments
required in business or professional matters. Ability to judge
wisely in some degree inherited, but may be developed by exer-
cise and self-criticism. Impulsive, capricious, or "snap" judg-
ments likely to be superficial and unreliable. Prejudice and
strong emotion warp judgment. Dogmatism and intolerance
usually based on narrow range of facts, and shallow thinking.
Until facts can be obtained, judgment should be suspended.
V. Conduct and Character
The third essential — will power or moral energy to control
vagrant or selfish impulses and carry out one's purpose and
ideals. High ideals and thoughtful decisions are ineffective
unless put into practice. Those who profess fine ideas and emo-
tions without doing anything to carry them out are called sen-
134 OUTLINES OF SUBJECTS
timentalists or hypocrites. Motive power comes from the
emotions and sentiments which are the springs of action as well
as the key to character. What a person is, is shown by what
he desires most, what annoys, pains, or grieves him, in what he
finds satisfaction. Disposition and temperament are largely
inherited, but character is made. It is the result of all one's
choices and actions, of all one's physical, mental or moral
habits. Important to make allies instead of enemies of one's
habits. Rules for habit-formation (see James). Action must
be vigorous and forceful as well as rightly directed — must be
applied consistently in all the affairs of every-day life.
VI. The Place of "the Self" in the Moral Life
Virtues are habits of will or modes of conduct which tend to
promote the welfare of both individual and collective life.
Vices are abnormal developments of the will that tend to en-
slave and destroy life. The normal impulse of individuals is to
satisfy the desires and claims of self. The higher welfare of
self includes the welfare of the larger group. Involves struggle
between egoism and altruism, between narrow selfishness and
benevolence. Self-control the mainspring of character — mas-
tery of the lower by the higher impulses. Suppression and
eradication of natural impulses and emotions and extreme
self-renunciation as advocated by ascetics tend to cripple and
narrow life. Self-expression and self-development to be em-
phasized, as well as self-denial and self-sacrifice. Courage or
persistent natural vigor needed to resist lower desires and
give moral power to meet pain, danger, and public disapproval,
when necessary. Strong character implies virility, vigor, and
strong moral fibre, not negative, spineless "goodyness." Mod-
esty (freedom from false pride and excessive desires), chastity,
self-possession, perseverance, fortitude, patience, constancy —
all aspects of self-control and courage. A high conception of
individual honor, self-respect, and wholesome ambition, essen-
tial to complete development of the self. Vanity, servility, ag-
gressiveness, etc. are perversions of the impulse to further
self's welfare and development.
VII. The Social Virtues
The parental or "motherly" instinct — the main root of the
social virtues. Tenderness, compassion, sympathy, pity, be-
nevolence, and helpfulness, generally expressed in various
forms of charity and philanthropy, such as caring for children,
the sick, helpless, and dependent. Unless safeguarded by
knowledge and good judgment, benevolence may be injurious
to oneself and others. Good will, or love of one's neighbor, is
incompatible with envy, malice, and all the subtle as well as
active forms of cruelty and selfishness. Patriotism or love of
one's country — another form of benevolence. Justice a funda-
mental social virtue, representing the idea of equity, rectitude,
PRINCIPLES OF ETHICS 135
fairness, impartiality, honesty as opposed to exploitation, op-
pression or injustice of all kinds. Veracity implies frankness,
fidelity, and sincerity in all human relationships as opposedto
lying, flattery, slander, and misrepresentation. Social virtues
of cooperation, good-will, fair play, give and take, enter into
every phase of human life and work.
VIII. Ethical Principles as Applied to Community Life
The growth of democracy in modern life. Result of growing
belief in the worth and possibilities of the individual and his
right to self-expression and development. Danger of over-
emphasis on individual rights and neglect of obligations. New
emphasis on social ends or group welfare, not incompatible
with individual development. Social efficiency the modern
ideal— highest self-realization and self-expression through
service for the common good Wide variation in types of serv-
ice and ability needed for community service. Public-spirited-
ness and patriotism expressed in the faithful doing of incon-
spicuous and common tasks as well as heroic deeds. Impor-
tance of training and efficiency as well as good-will. Recent
changes in the status of women and new possibilities of public
service opened up. Local questions of family and community
welfare discussed from the ethical point of view with practical
suggestions for useful service.
IX. Principles of Ethics as Applied to One's Work or Profession
The relation of various forms of occupation to community
welfare. Ideals and traditions of service developed by such
professions as the church, the army, medicine, etc. The
spirit of the craftsman or artist in relation to his art. Putting
one's soul into one's work. The value of work as .a means of
happiness, personal satisfaction, and development. "/Growth in
independence, integrity, industry, and self-respect through
work. The "business-like" qualities and virtues — system,
thoroughness, promptness, alertness, economy, reliability, and
persistence. Qualities demanded in working with others —
loyalty and intelligent cooperation with those in charge, trust-
worthiness, ability to do good team-work, spirit of courtesy
and helpfulness, a sense of humor, discretion. Qualities neces-
sary in leading and guiding others' — good judgment, justice,
dignity, generosity, initiative, enthusiasm, self-reliance, and
the ability to take responsibility. Dangers of narrowness and
stagnation in relation to one's occupation; of materialism, cyni-
cism, and mechanical routine. Effects of over-fatigue, and
over-work as well as idleness in breaking down moral resistance,
decreasing moral sensitiveness, and sapping energy and spirit.
X. Principles of Ethics as Applied to One's Personal Life
The importance of having definite purposes to work towards,
laws to obey, ideals to follow. Self-direction and self-mastery
achieved thrpugh concentration and practice. The place of
136 OUTLINES OF SUBJECTS
religion in the building of character, and the development of
one's spiritual life. Essentials of an attractive, wholesome,
and strong personality. Its influence on others. Possibili-
ties of strengthening weak moral fibre and cultivating hidden
resources of personality and ability in others. The ability to
meet moral crises in one's own life and the lives of others.
Provision for growth. What we mean by self-government.
Application of foregoing principles to special problems, es-
pecially those involved in recreation, amusements, and social
life, dress and the expenditure of money, relations between
men and women, friendships, etc.
METHODS OF TEACHING
l.'The practice of ethics is a matter of attitude, spirit, and
1-Will more than knowledge. Teaching will never be effective in
changing behavior unless it is backed up by the example and
personality of the teacher and by the atmosphere and influ-
ences which surround the pupil every day. Every subject
taught in the training school should be a medium for teaching
ethics, and every problem which the pupil meets in her daily
work should be an opportunity for practice in ethics. The
social life of the pupil nurse is a particularly strong influence
in shaping her ideals and developing her powers. Emphasis
should be laid on the formation of habits of positive service
and helpfulness rather than merely the correction of faults
and the observation of rules and regulations; on the strength-
ening of character through complete development rather than
the repression and elimination of the more undesirabletraits.
If the principles of student government are in force in the
Nurses' Home, it will give a much better opportunity for exer-
cising the qualities of self-direction and self-control in regard
to the pupils' personal life.
2. In teaching ethics, concrete examples should be given to
illustrate every point, or to lead up to the discussion. These ex-
amples will be found in history and standard literature, poetry,
current fiction, newspaper items or personal experiences.
It is better not to draw too many examples from hospital life
but to give as broad a point of view as possible. Pupils should
be asked to bring in examples and to contribute to the discus-
sions in every possible way. The course should be tied up
with the earlier course in the historical and social aspects of
nursing and to psychology if this is given. It might follow the
course in psychology or be combined with it if there is not time
for both.
3. If possible personal conferences might supplement such a
course. The teacher could thus get into closer touch with the
pupils and could help them better in working out their indi-
vidual problems.
SURVEY OF THE NURSING FIELD 137
TEXT AND REFERENCE BOOKS
Robb: Ethics of Nursing.
Parsons: Nursing Problems and Obligations.
Nightingale : Notes on Nursing.
Nightingale: Talks to Pupil Nurses.
Osier: Aequanimitas.
Dewey and Tufts: Ethics.
Mackenzie: Manual of Ethics.
McDougall: Social Psychology.
James: Talks to Teachers.
McCunn: Making of Character.
Emerson: Essays.
Cabot, (E. L.) Every-Day Ethics.
Cabot, (Richard) What Men Live By.
See also under Historical, Ethical and Social Aspects of
Nursing, Psychology and Problems of Professional Life.
Survey of the Nursing Field
TIME: 10 hours,' — lectures, classes and conferences conducted by the
superintendent of nurses and special lecturers representing
different fields. Given in the early part of the third year.
OBJECTS OP COURSE
1. To introduce the pupil nurse to all the varied branches of
nursing work, so that she may be more able to choose the
field in which she is likely to find the greatest interest and
success.
2. To show pupils what is being done in all these important
fields, what the main problems are and what their responsi-
bilities are in connection with them.
OUTLINE OF CLASSES
I. Introduction
Brief survey of the historical development of nursing work
showing the division into three main branches of hospital,
visiting and private nursing. Later subdivision of each of
these main branches into many distinct fields. Reasons why
nurses should choose future work with care. Points to be
considered in choice of vocation. Need of further training for
special branches or positions of leadership. Kinds of train-
ing available. Points to be considered in regard to post-gradu-
ate training.
II. Hospital or Institutional Nursing
History of the origin and development of hospital nursing
reviewed. Nature and general conditions of work, salaries,
qualifications and preparation for executive positions, such as
hospital superintendent, assistant superintendent, dietitian,
138 OUTLINES OF SUBJECTS
housekeeper, matron of nurses home, etc. Technical special-
ties such as operating-room work, administration of anes-
thetics, massage, hydrotherapy, electro-therapy, laboratory
work, etc. Duties, opportunities, qualifications and training
demanded.
III. Educational Work in Hospitals
The origin and development of training schools and the
work of the training-school as distinguished from that of the
hospital. The position and duties of the superintendent of
nurses, assistant superintendents, instructors and head nurses.
Qualities and training demanded. The scope of educational
work in nursing schools. Number of training schools in U. S.
(approximately 1570). Growing importance of this field.
IV. Visiting Nursing (General)
The origin of visiting nursing under deaconesses and older
religious orders reviewed. Later secular orders, and rise of
modern visiting nursing. Outline of modern expansion at
home and abroad. Leaders in this field. Outstanding features
of visiting nursing in urban and rural districts. Work of town
and country nursing service. Visiting nursing in connection
with insurance companies, etc. Duties of visiting nurse —
qualifications and training demanded.
V. Infant Welfare Work and School Nursing
Origin of modern movements for conservation of children.
Nurse's part in this movement at home and abroad. Baby-
welfare work in hospitals, dispensaries, milk stations and
homes. Pre-natal work. Origin of school nursing and rapid
expansion of this field. The position and duties of such nurses
including resident nurse in school or college dormitory. The
qualifications and training demanded.
VI. Tuberculosis and Industrial Nursing
Place of the nurse in the tuberculosis movement. Kinds of
positions open to nurses both in institutional and visiting
work. The special needs of this field. The new industrial
welfare work for nurses — its nature and possibilities. Duties,
salaries, requirements and training of nurses for these branches.
VII. Mental Hygiene and Medical Social Service
History of the care of the insane reviewed. The place of the
nurse in mental hygiene and mental nursing. Kinds of posi-
tions open in both institutional and visiting work. The un-
usual demands and opportunities in this field. The origin and
development of medical social service. The nature of the work
and the demands, requirements and special preparation of
nurses for these fields.
VIII. Red Cross, Army and Navy Nursing
History of the Red Cross and army nursing. Organization
of nursing service for war and other disasters in America and
in other representative countries. Service in army and navy
SURVEY OP THE NURSING FIELD 139
hospitals. Nature and possibilities of such work. Require-
ments and special preparation of nurses for these fields.
IX. Private, Hourly and Office Nursing
Origin and development of these branches. The scope of
the field. Duties and economic status of private nurse. Pros-
pects for advancement. Newer specialties in private nursing.
Qualifications required and preparation for each of these
fields.
X. Miscellaneous Branches
Nursing in home and foreign mission fields, inspection of
Training Schools, work of hospital consultant, work of secre-
tary or organizer of philanthropic or public health organiza-
tions, almshouse and prison nursing, sanitary inspection,
teaching of invalid occupations, etc. Nature and general
conditions of work in all these fields. Salaries, qualifications
and preparation demanded.
METHODS OF TEACHING
1. Class or lecture method, especially interesting if special-
ists in the representative branches could come in and tell of
their work.
2. If at all possible, students should have an opportunity of
observing something of the principal branches of work out-
side of the hospital and should have enough experience in each
of the three main branches to enable them to test out their
aptitudes and determine which field they want to enter.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Books, pamphlets, journals and pictures, lantern slides.
TEXT AND REFERENCE BOOKS
Nutting and Dock: History of Nursing, vols. I-IV.
Robb: Nursing Ethics.
Robb: Educational Standards
Wald: The House on Henry Street.
Opportunities in the Field of Nursing: (Pamphlet.)
Perkins: Vocations for the Trained Woman.
Kingsbury: Vocations for Trained Women.
Morley: Women Workers in Seven Professions.
Gulick and Ayres: Medical Inspection in Schools.
Boardman: Under the Red Cross Flag.
La Motte: Tuberculosis Nursing.
Crowell: Tuberculosis Dispensary Method and Procedure.
Waters: Visiting Nursing in the United States.
Cannon: Social Work in Hospitals.
De Witt: Private Duty Nursing.
Gardner: Public Health Nursing.
Struthers: School Nursing.
Parsons: Nursing Problems and Obligations.
140 OUTLINES OF SUBJECTS
Reports of League of Nursing Education.
American Journal of Nursing: (Complete Files).
Public Health Nurse Quarterly.
See also under Private Nursing, Public Health Nursing,
Institutional Work and Professional Problems.
Professional Problems
TIME: 10 hours. Classes and conferences conducted by the superinten-
dent of nurses, and special lectures. Given in the later part
of the senior year.
OBJECTS OF COURSE
1. To anticipate some of the problems which will confront
the pupils when they graduate, and to help them to meet
their difficulties in a rational high-minded and effective way.
2. To awaken their interest in professional organizations,
and to secure their enthusiastic cooperation in advancing the
mutual interests of the public and their own profession.
(Special problems of the private nurse, the public health
nurse, and the institutional nurse are considered in courses
on these subjects.)
OUTLINE OF CLASSES
I. The Social and Civic Status of Nurses
Claims of nurses to professional status based largely on serv-
ice rendered to the public and on controlling ethical, and edu-
cational principles. Responsibility of individual nurse in
maintaining professional and social status. Qualities and con-
duct which make one acceptable in good society. The nurse
as a citizen and public servant. What the community has a
right to expect of her. Duties in times of crisis- — war, epidem-
ics, etc. Responsibility for community health and welfare1.
Relationship to civic, philanthropic, religious, educational and
public health agencies and activities. Relations to women's
clubs and organizations which aim to advance the welfare of
women.
II. Professional Ethics and Etiquette
Origin of the ethical code of medicine. Accepted forms of
professional courtesy. Relation of the nurse to the physician
in all the various branches of nursing work. Relations of indi-
vidual nurses to one another, and to the profession as a whole.
The necessity of loyalty, harmony and cooperation. Primary
rights of the patient and patient's family in case of doubt. Pos-
sible conflicts between the general good and professional soli-
darity. Nurses' attitude to incompetents, irregulars, and
quacks in both nursing and medical professions. Professional
courtesies toward representatives of related professions and
occupations.
PROFESSIONAL PROBLEMS 141
III and IV. Nursing Economics
The economic status of the nurse as compared with other
professional women. The professional as opposed to the com-
mercial spirit. The economic independence of the modern pro-
fessional nurse compared with the comparative dependence of
the religious orders. Provision for sickness and retirement.
Business principles, as applied to bills, banking, investments,
insurance, etc. The nurse's budget. Proportion of yearly in-
come spent in rent, board, clothing, etc. Principles of econ-
omy. Loan and relief funds for nurses. The sliding scale of
charges. Provision for maintenance of health and working ca-
pacity. Regulation of conditions of work in all branches of
nursing — hours, vacations, living conditions, rest, sleep, food,
etc. The social life of nurses. Provision for recreation and
self-improvement. Nurses' clubs and hostels. Nurses' regis-
tries. Professional vs. commercial bureaus. The central reg-
istry— how it should be maintained and managed.
V. Legal Problems (given by a lawyer)
Laws which affect the nurse in her relations with patients,
physicians, hospitals and the general public. Legal situations,
in which a nurse may be involved' — accidents, sudden death,
poisoning, suicide, homicide, insanity, etc. Court procedures
— especially those involving testimony by nurses. General
advice to nurses in all cases where legal difficulties arise.
VI. Nursing Education
Educational status of nursing as compared with other pro-
fessions. Economic difficulties in establishing a sound basis
for nurses' education. Need of independent endowments for
Training Schools, better applicants, higher standards of edu-
cation, suppression of commercial and inferior schools. What
constitutes a good school of nursing. Development of univer-
sity affiliations. Work of Nursing and Health Department at
Teachers College, Columbia University and other university
courses, Nurse's responsibility for adding to her own efficiency
and increasing the general fund of professional knowledge.
VII. Nursing Legislation
Registration of nurses through legislative enactments as a
valuable means for controlling the practice of nursing and the
education of nurses. History of the registration movement in
America. Essentials of a good bill, and measures for its
enactment. Present status of nursing legislation in different
states.
VIII. Nursing Organizations (general and alumnae)
What organization has done for nurses. Essential elements
in any organization. Types of nursing organizations. Aims
and activities of the alumnae. Duties of nurses toward pro-
fessional organizations. Elements of organization and parlia-
mentary procedure for use in nursing organizations.
142 OUTLINES OF SUBJECTS
IX. National Nursing Organizations and Publications
Development, main activities and general plan of the Ameri-
can Nurses Association, League of Nursing Education and Na-
tional Organization of Public Health Nursing. State and
local branches. Publications and reports. The nursing press
— American Journal of Nursing, Public Health Nursing Quar-
terly, and other publications. Dangers in commercialization
of nursing publications.
X. International Relationships
Origin, aims, and activities of the International Council of
Nurses. Brief survey of countries represented, noting general
hospital and nursing situation, social, educational and eco-
nomic status of nurses, leading women and publications. Atti-
tude toward nurses of other countries. Means for the promo-
tion of friendly and helpful relationships with other countries.
Opportunities for assisting in the development of nursing in
backward countries.
METHODS OF TEACHING
1. Use the discussion method as far as possible. Have
pupils read short papers, prepare bibliographies, and bring
problems to class for discussion. The case method can be
used to advantage in many of these topics, basing the discussion
on actual situations that have occurrred.
2. Personal conferences with pupils are found to be very help-
ful in this course. It is evident that more time is needed to
deal with the subject in any adequate way. Many additional
topics could be suggested for supplementary work — such as a
short course on public speaking and parliamentary law. It
would be very helpful also to have the nurses organize a jour-
nal club to run parallel with this and other -courses in the
senior year. A few important journals might be selected and
one assigned to each member of a class for review. Probably a
better plan is to assign a topic to each pupil and have her
search for important articles on that topic. Brief reports on
these articles are given, and filing cards with name, author,
reference and annotations are filed for the use of the club mem-
bers. Students should be encouraged to use discrimination
in the selection of articles and to give the gist of the contents
only in the report. Time should be left for discussion.
ILLUSTRATIVE MATERIAL
Journals, books, photographs, charts, etc.
REFERENCE BOOKS
Nutting and Dock: History of Nursing, vols. I -IV.
Nutting: Educational Status of Nursing (published by Bureau
of Education, Washington).
Robb: Nursing Ethics.
MODERN SOCIAL CONDITIONS 143
Robb: Educational Standards.
Nightingale: Notes on Nursing.
Osier: An Alabama Student and other Essays.
Osier: Aequanimitas.
Paget: Confessio Medici.
Parsons: Nursing Problems and Obligations.
Reports of National League of Nursing Education.
Reports of International Council of Nurses.
American Journal of Nursing.
Public Health Nurse Quarterly.
Nurse's Journal of the Pacific Coast.
Canadian Nurse.
British Journal of Nursing.
Modern Hospital, etc.
See also books on History of Nursing, Nursing Ethics, Mod-
ern Social Problems, etc.
Modern Social Conditions
TIME : 10 hours, to be given by authorities on the various topics outlined,
or by an expert in Social Economy or Social Science. Given
in the latter part of the third year.
OBJECTS OP THE COUESE
1. To give the pupil a general understanding of the broad
fundamental problems inherent in society today, showing the
methods of approach and the agencies at work in attempting
to solve these problems.
2. To make the nurses sufficiently familiar with the present
emphasis in methods of social work so that they will have some
basis for further reading and study, also to serve as a back-
ground for public health nursing and other forms of social work.
3. To further emphasize the close relationship between
health and social problems.
I. Poverty and Philanthropy
Brief historical sketch of the development of society, show-
ing how as the organization of society became more complicated
the emphasis shifted from the individual to the group. In
philanthropy this meant organized scientific treatment of social
problems, rather than the spasmodic efforts of benevolent in-
dividuals. Present tendency toward governmental action —
federal children's bureau, state, country and local public health
agencies, state employment agencies, social legislation, etc.
Change in conception of poverty — no longer considered dis-
tinct from other problems, but rather the result of them and
must be attacked through them. Treatment of poverty insep-
arable from treatment of all the various social ills — unnecessary
144 OUTLINES OF SUBJECTS
sickness, dependency, feeble-mindedness, insanity, physical
or mental degeneracy, physical handicaps, insufficient wages,
unemployment, etc.
II. Delinquency and Crime
Causes of delinquency1 — hereditary and environmental. De-
fectives1— diagnosis and treatment; psychological and mental
clinics, tests; ungraded classes, segregation in institutions
with special occupation training. Close relation between men-
tal diseases and delinquency. Special problem of juvenile
delinquency. Treatment- — proper recreation, schools adapted
to the needs of the individual, socializing court action, proba-
tion officers, prison reform, making correctional institutions
stand'for the highest development of the individual rather than
the punishment of offense, the indeterminate sentence.
III. Education and Recreation
Modern conception of education and recreation. Schools to
be the center and guide in all activities, mental, physical and
social, assisting each child to develop his highest potentialities
along these various lines. Vocational guidance through schools
The industrial school. Recognition of the importance of play
for normal development. Natural desire for play when mis-
directed may lead to delinquency and immorality — gangs, gam-
bling, dance halls, etc. Boys and girls clubs1 — Boy Scouts,
Girl Scouts, Junior Police, etc.
IV. Social Hygiene
The far reaching effects of the sex instinct. Individual and
social ills that come through lack of understanding and mis-
use. Mental and physical diseases, immorality, prostitution
and illegitimacy. Desirability of frank intelligent conception
of the significance and proper place of the sex instinct. Sex
education — how and by whom to be given. The problem of
prostitution and agencies for its control and prevention.
V. Alcohol and Drugs
The problem of alcohol and drugs in relation to poverty,
unemployment, crime, prostitution, insanity and other social
and health problems. History of the movement for the con-
trol of alcoholism. Scientific investigations into effects of
alcohol and their results. Causes and effects of the drug habit.
Methods of handling cases and preventing sale of drugs.
VI. Modern Industry
Brief survey of some modern industrial problems. Unem-
ployment. Women and children in industry. Labor organi-
zations both for employer and employee. Use of the strike.
The protocol and boards of arbitration. Tendency toward
governmental control of industry in the interest of common
welfare. Labor legislation — regulating hours, minimum wage,
child labor, working men's compensation.
MODERN SOCIAL CONDITIONS 145
VII. Immigration and Race Problems
Causes of emigration from other countries. Dominant race
traits and social backgrounds. Problems of assimilation.
Influences which stimulate and retard adjustment and develop-
ment. Direct efforts toward safe-guarding the immigrant.
Relation of the immigrant to industrial problems.
VIII, IX and X. Agencies and Methods for Relief and Prevention
General principles of case work — family the unit. Social
diagnosis and treatment with special factors to be considered.
Relief agencies' — use of relief as social treatment. Society
for Organizing Charity, etc. Children's agencies — Children's
Aid Society, Society for the Prevention of Cruelty to Children,
etc. Specialized agencies' — for wayward girls, for mental cases,
for court cases, etc. Value of social records and social sta-
tistics— their interpretation. Methods of education and
publicity. Mass methods' — settlements, social centers, play-
grounds, etc. Value of schools, churches, theaters, the press,
etc., as social agencies. Social legislation. Work of the Con-*
sumer's League; Child Labor Committee, etc. Labor Legis-
lation. Social Insurance. Old Age and Widow's Pensions.
METHODS OF TEACHING
1. Lectures and reference reading, followed by class discus-
sion or conference, if possible, with the lecturer, or by the
Head of the Social Service Department or someone actively
engaged in social work.
2. The lectures must necessarily be sketchy in character,
giving but a bird's eye view of the subject and should be given
in simple non-technical terms.
3. Excursions should be made, if at all possible, to the in-
stitutions and agencies dealing with these particular problems
in the community.
4. The assignment of reading is most important, as this should
supplement the necessarily limited ground covered by the
lectures. As the time usually available is very limited assign-
ments should be brief and very carefully selected.
TEXT AND REFERENCE BOOKS
Ellis: Task of Social Hygiene.
Devine: The Normal Life.
Addams: Democracy and Social Ethics.
Streightoff : Standards of Living.
Hunter: Poverty.
Devine: Misery and its Causes.
Devine: Principles of Relief.
Henderson: Dependents, Defectives and Delinquents.
Healy: The Individual Delinquent.
Loch: Charity and Social Life.
146 OUTLINES OF SUBJECTS
Publications of the New York State Committee on Mental
Hygiene.
Addams: The Spirit of Youth and the City Streets.
Lee: Play in Education.
Abbott: Women in Industry.
Richmond, Mary: Social Diagnosis. Russell Sage Founda-
tion.
Schreiner: Woman and Labor.
Publications of the American Association for Labor Legislation.
Antin: The Promised Land.
Steiner: Ebb and Flow of the Immigrant Tide.
Zangwill: The Melting Pot.
Devine: The Spirit of Social Work.
Cabot: Social Service and the Art of Healing.
Addams: Twenty Years at Hull House.
Addams: A New Conscience and an Ancient Evil.
Wald: The House on Henry Street.
Seager: Social Insurance.
Proceedings of the National Conferences of Charities and
Corrections.
The Survey.
See also under History of Nursing, Survey of the Nursing Field,
etc.
NOTE' — Lectures devoted to the social aspects of special classes of dis-
ease, will be found under such subjects as Obstetrical Nurs-
ing, Children's Diseases, Communicable Diseases, etc. If not
covered in this way, such topics might be included under
Modern Social Conditions.
G. SPECIAL BRANCHES OF NURSING
Introduction to Institutional Work (Elective)
TIME: 10 hours. Classes and conferences conducted by the principal
of the training school. Course to be given in latter part of
third year.
OBJECTS OF COURSE
To give the student a better understanding of some of the
problems and responsibilities of the supervisors and head
nurses in charge of various hospital departments. The course
is intended for students who have shown special ability along
executive lines, and who intend to continue in hospital work.
No attempt should be made to deal with the larger and more
responsible duties which belong to hospital and training school
administration.
OUTLINE OF CLASSES
I. Hospital Organization
Different types — municipal, state, private, semi-private.
Study of general plan of organization in hospital. The ward
as a hospital in miniature — needs of ward as sample of needs
of hospital as a whole. Relation of ward to other departments
of hospital — kitchen, laundry, linen and supply rooms, phar-
macy, social service department, training school, admitting
department, general office, etc.
II. Ward Planning and Equipment
The planning of wards and accessory rooms; size and arrange-
ment for convenience in work ; finish and structural equipment.
Standard hospital furnishings. Average allowance of linen,
utensils, etc., per patient. Standardization of equipment
for different types of work. Consideration of use, cost, special
advantages, durability, sanitary features, etc. Economy in
use of equipment and supplies. Care and renewal of supplies.
Methods of exchange. Responsibility for medical and surgical
supplies on wards. Methods of purchase — contract, open
market.
III. Ward Personnel and its Organization
Responsibility of head nurse for ethical atmosphere. Influ-
ence of her personality in developing esprit de corps of the ward.
The head nurse as a judge of character. Especial responsi-
bility toward the new probationers. Relation of head nurse
to visiting staff, house staff and nurses, students and employees.
Arrangement of ward services, hours of work for nurses, off-
duty time, etc. Reasons for the eight-hour day and various
systems of carrying on ward work on this basis. The night
nurse and her special problems. Special nurses — hours of
147
148 OUTLINES OF SUBJECTS
work, relief, etc. Relation of head nurse to maids and order-
lies— interest in their hours of work, living conditions, recrea-
tion, etc.
IV. The Head Nurse and the Patients
Purpose of hospital — care and comfort of patients. The
rights and obligations of patients in a hospital. Reception of
patients — first impressions. Hospital noises' — how to mini-
mize. Respect for religious and racial differences and peculiar-
ities. Opportunities for social service. Some principles of
psychology used in the handling of patients. Occupations for
ward patients. Relation of head nurse to patients' friends.
Attitude and support of community influenced largely by per-
sonal care and consideration of patients and attitude toward
their friends and relatives. Care of patients' clothing and
property.
V. The Head Nurse as an Executive
Some principles of good management — collectiveness and
cooperation. Capacity for leadership — how developed. Dan-
gers of arbitrary leadership. Staff and line functions. Rela-
tion of head nurse to other hospital departments. Assignment
of work. Value of schedules. Delegation of responsibility.
Discipline — its meaning and purpose. Test of ability for
executive work. Opportunity for individual development.
VI. The Head Nurse as a Teacher
Teaching functions of the head nurse — what they involve.
Value of bedside teaching. Supervision and constructive crit-
icism of work, done by nurses. Perfection of technique,
standardization of work, motion study. Need of keeping in
touch with theoretical teaching given to nurses. Cooperation
with instructor of nurses. Head nurse as teacher of applied
hygiene and sanitation to patients and public. Head nurse as
teacher of ward maids and orderlies in methods of house work,
care of cleaning utensils, cleaning process and agents, etc.
VII. Ward Housekeeping
Review of general principles of household economics. Estab-
lishment of standards. Inventories. Stock-taking. Repairs
and renewals. Disposal of garbage and waste. Prevention of
pests. Supervision of maids and orderlies. Schedules of work
—daily and weekly cleaning. Care of diet kitchen, refrigera-
tors, etc. Care of lavatories. Private rooms and their care.
Surgical dressing rooms, service rooms, balconies, etc.
VIII. The Patient's Food
Food — its preservation, preparation and service. Dietaries
for ward and private patients — need of personal supervision
of head nurse. Special diets— caloric feeding, etc. Feeding
helpless patients. Prevention of waste. Diet sheets and
their importance. Care of food trucks. Question of allowing
food to be brought to patients by their friends. Problems in
INTRODUCTION TO PRIVATE NURSING 149
relation to racial and personal preferences in diet, religious
observances, etc.
IX. Records and Record Keeping
Value of records and their functions — to hospital adminis-
tration— to medical staff — for protection of nurse. Card in-
dex system. Hospital cost accounting. Ward inventory.
Daily reports, charts, orders, etc. Necessity for scientific
accuracy, judgment, neatness. Honesty in record-keeping as
test of character.
X. Special Problems in Ward Management
Application of foregoing principles to work in various de-
partments— medical, surgical, obstetrical, children's operat-
ing room, dispensary^ etc. Opportunities for continued edu-
cation and training of the nurse in the hospital. Dangers of
too narrow specialization, and the institutional point-of-view.
Importance of outside interests and diversions, and a whole-
some and normal social life. Opportunities for advancement
open to head nurses and supervisors. Importance of constant
study and self-improvement through reading, journal clubs,
visiting other institutions, etc.
NOTE: If not given as part of the regular nurses' training it
is suggested that the above outline might serve as a suggestive
basis for head nurses' conferences.
METHODS OF TEACHING
A course of this kind will usually take the form of a more or
less informal class discussion. The idea is to have the stu-
dents assisting head nurses in some of the departments of the
hospital where they will be in close touch with many of the
problems under discussion. Individual problems may be
assigned for investigation and reported on in class.
TEXT AND REFERENCE BOOKS
Palmer: The Teacher.
James: Talks to Teachers.
Taylor: Shop Management.
Pillsbury: Essentials of Psychology.
Nutting: Educational Status of Nursing.
Robb: Nursing Ethics.
Robb: Educational Problems.
Parsons: Nursing Problems and Obligations.
Cannon: Hospital Social Service.
Standard Curriculum for Nursing Schools.
Articles in The American Journal of Nursing, Journal of
Home Economics, The Modern Hospital, etc.
Introduction to Private Nursing (Elective)
TIME: 10 hours. Class work, discussions and demonstrations conducted
by a member of the staff who has had experience in private
150 OUTLINES OF SUBJECTS
nursing, or by a specially qualified private nurse. To be given
in the latter half of the third year.
OBJECTS OF THE COURSE
To discuss in detail the more important problems which
confront the nurse in private duty, and to establish the underly-
ing principles of successful private nursing and suggest modi-
fications or adaptations of hospital technic which may be re-
quired in this work. The course is intended only for those
students who expect to go into the private nursing field.
OUTLINE OF CLASSES
I. Essentials to Success in Private Duty
Considerations which would determine the choice of this
branch of work. Demands on health — need of special atten-
tion to rest, exercise, food, etc. Requirements as to personality
and character. Professional requirements — special kinds of
skill, intelligence and efficiency required. Social requirements
— knowledge of social customs and observances which make
one at home in good society. Companionship — resourceful-
ness in providing diversion and entertainment for patients
when necessary. Educational functions of the private nurse.
Opportunities for teaching and influencing homes and com-
munities.
II. Establishing One's Self in Private Practice
Where to locate? The relative advantages of larger and
smaller centers. Special needs of the small town. Impor-
tance of joining a good registry. Rules of the registry. The
responsibility of the private nurse for the care of sick patients
of all types and conditions. The ethics of picking and choosing
among cases. General nursing versus specialization in private
nursing. How to get in touch with physicians and hospitals.
Engagements and charges. Identification with local nursing
interests. Relationship with nurses from different schools,
practical nurses and attendants.
III. Living Conditions and Expenditures
The private nurse's income — proportion to be devoted to
professional and personal expenses. Requirements in clothing.
Recommendations as to uniforms, street clothes, clothes for
night duty, shoes, etc. Equipment required for general, spe-
cial, hospital and country cases. The contents and packing of
the private nurse's suit case. Problems of living. Choice of
a room and provision for meals when off duty. The relative
advantages of the nurses' club, cooperative housekeeping and
boarding. Importance of good telephone service. Laundry
problems. Proportion of income to be spent on recreation and
personal improvement. Importance of the savings fund and
INTRODUCTION TO PRIVATE NURSING 151
insurance as investments. (Demonstrate proper costume for
private nurse — out-door and in-door; also private nurse's suit-
case with outfit.)
IV. The Nurse in the Home
The position of the nurse in the family. Relationship to
the patient, the members of the family, servants and visitors.
Looking at things from others' point of view. How to secure
the assistance and cooperation of the patient and family. The
choice, arrangement and care of the sick room. The ordering
and serving of meals. Preparation of special diets in the home.
Economy in sick-room supplies. How to improvise equipment.
Adaptation of treatment with limited equipment. The im-
portance of records. The daily routine in ordinary cases.
V. Special Duty in the Hospital
Conditions of special duty in various types of hospitals.
Customary regulations concerning hours, relief, room, board,
remuneration, etc. Relation of the special nurse to the offi-
cers of the hospital and training school, visiting and resident
physicians, pupil nurses, ward-maids and orderlies, and other
special nurses. Duties of the special nurse on ward or private
cases. Reportls and records. The use of hospital supplies.
Night work in the hospitial. Cooperation of nurses on the same
case.
VI. Hotel Life and Travelling
Special difficulties presented by hotel life. Problems of uni-
form, meals, relief, etc. Relationship of the nurse to hotel
management, staff and guests. Preparation for travelling at
home and abroad. Requirements and conveniences for both
patient and nurse. How to pack a trunk and attend to bag-
gage. Management of the journey. Arrangements for meals,
transportation at station, etc. What to do for train-sickness
and sea-sickness. Special points in travelling with a baby, a
male patient, a bed-patient, an insane or nervous patient, etc.
(Demonstration of packing a trunk might be given by an
expert.)
VII. Private Duty in the County and under Pioneer Conditions
Typical cases in camps, isolated districts and country com-
munities. Conditions which have to be met in the country.
Necessity of understanding people and their ways. Arrange-
ments as to food, supplies, relief, etc. Responsibilities which
rest on the nurse in the absence of the doctor. Disposal of
excreta and other sanitary precautions in the country.
VIII. Special Problems in Obstetrical and Surgical Cases
Preparation for confinement in a private house, especially in
an emergency case. The care and training of the baby. Pre-
paring feedings in the home. The surgical case. Preparation
for operations and surgical dressings in the home. Methods of
sterilizing under home conditions.
152 OUTLINES OF SUBJECTS
IX and X. Special Problems in Medical Cases and Emergencies
The contagious case. Technic of isolation in private homes.
Rules for the nurse after caring for different types of infection.
The care of sick children of different ages — management dur-
ing convalescence. The chronic case — special demands on the
nurse in long continued cases, such as paralysis, tuberculosis,
heart disease, etc. The care of the aged. Nursing mental
and nervous patients. Special problems involved in caring for
male patients — avoidance of compromising situations. What
to do about special forms of treatment for male patients. What
to do in case of death — in private house, hospital, or when
travelling.
METHODS OF TEACHING
1. Class work should be conducted largely by means of dis-
cussion. Problems and cases should be suggested and pupils
encouraged to work them out and report on them.
2. If possible each pupil who expects to do private nursing
should spend a limited time in the care of special patients in
the hospital, preferably in general wards. This should cover
a variety of cases and should not be extended over a period
of more than a few weeks. The class work should be con-
nected as closely as possible with this practical work.
ILLUSTRATIVE MATERIAL AND EQUIPMENT
Articles and photographs illustrating the subject.
TEXT AND REFERENCE BOOKS
De Witt: Private Duty Nursing.
Lounsbury: Making Good on Private Duty.
Nightingale: Notes on Nursing.
Robb: Nursing Ethics.
Parsons: Nursing Problems and Obligations.
Back files of the American Journal of Nursing, and other
periodicals.
Introduction to Public Health Nursing and Social Service (Elective)
TIME: 10 hours. Conducted by the head of the social service depart-
ment, the superintendent of the visiting nurse society or special
teacher of this subject. Given in the latter part of third year.
OBJECTS OF THE COURSE
1. To give the pupil nurse a theoretical background for the
field work which she is receiving, so she may understand the
significance and importance of the various problems met in
practical work whether it is visiting nursing or hospital social
service work.
2. To teach her something of the technique and procedure
to be followed in this type of work, so that she may be ready
INTRODUCTION TO PUBLIC HEALTH NURSING 153
on leaving the training school to enter one of the commoner
fields of public health nursing as a useful staff worker, with
some general idea of case work and routine visiting in families,
and with some vision of the ideals toward which she should
aim in the further development of such work.
OUTLINE OF CLASSES
I and II. Introduction
Brief history of the development of visiting nursing. De-
fine purpose and principles which underlie public health nurs-
ing organizations' — by whom organized, how supported and
governed, what elements the Board represents, committees
and their functions, etc. Function and scope of work — care of
the sick, prevention of disease, constructive social case work.
Relation to the hospital, to doctors, to municipal, philan-
thropic, medical and social agencies, to the community and to
the patient.
III. Theory and Technique of Case Work
Meaning of social diagnosis and social treatment. Empha-
sis on family treatment. Factors to be considered in all case
work — mental and physical heredity, family influences, educa-
tion and training, occupation, income, recreation. The rela-
tion of these factors to health. Importance of first interview
and first home visit.
IV. Source of Cases and Basis of Selection
Cases sent by doctors, nurses, private individuals, organiza-
tion (business, religious and philanthropic,) social service
workers, and other patients. Methods of referring — details.
Various bases of selection in hospital social service and visiting
nursing.
V and VI. Case Work in Visiting Nursing
Freely illustrated from case histories, showing exact pro-
cedure and methods in treatment from the first step after case
is referred to the last step when case is terminated. Home nurs-
ing technique in various diseases. The nurse's bag — its equip-
ment and care. Special nursing and social problems presented
by acute, chronic and contagious cases when cared for in the
the home. Care of children in home vs. hospital care.
VII. Case Work in Hospital Social Service
Types of cases especially requiring medico-social treatment.
Enlarge upon social causes and social results in each instance.
Medical — tuberculosis, cardiac, stomach, diabetes. Obstetri-
cal— prenatal and sex problems. Pediatrics — feeding cases,
instruction in care of children. Orthopedic. Mental and
nervous. Venereal diseases. Illustrate from case histories.
VIII. Office Methods
Records — importance and purpose. Study of record sheets
and history taking. Resource catalogue and other devices
making for greater efficiency and time saving.
154 OUTLINES OF SUBJECTS
IX and X. Modern Tendencies and Special Problems
Hospital social service — shall relief be given by social serv-
ice department? Limitation of intake of work, preventive
work, community work. Use of voluntary workers. Visit-
ing nursing — hourly nursing, generalization versus specializa-
tion, relief-giving, the visiting housekeeper and attendant
service in connection with Visiting Nurse Association. Pos-
sibilities of dietary work, surveys, focusing on new problem
each year, research. Specialization vs. centralization in Pub-
lic Health Nursing. Community Centers.
METHODS OF TEACHING
1. The course should be conducted as a conference rather
than a lecture course, the person conducting the course pre-
senting her material first but allowing questions during presen-
tation and always leaving time for free discussion afterwards.
2. There should be constant use of cases seen in the ward
and Social Service Department or Visiting Nurse Society.
Each nurse might be assigned a particular type of case to-
present to the group from her own experience either in the
hospital or Social Service Department.
3. While of necessity the local situation must figure largely
in the material considered, each nurse should be required to-
describe the work done in some other city as discovered through
annual reports, correspondence, etc., thus bringing out the
variety of development possible in the work and enlarging the
nurse's knowledge of other than the local situation.
4. The ground covered and the emphasis on different topics
will necessarily vary widely. The above outline is suggestive
merely.
ILLUSTRATIVE MATERIAL
Reports of various Social Service Departments and Visit-
ing Nurse Societies. Photographs, posters, exhibits, etc.
TEXT AND REFERENCE BOOKS
Gardner: Public Health Nursing.
Foley: Visiting Nurse Manual.
Wald: The House on Henry Street.
Cabot: Social Service and the Art of Healing.
Cannon: Social Service in Hospitals.
Devine: The Normal Life, Misery and Its Causes.
Davis & Warner: Dispensaries.
The Proceedings of the National Conference of Charities and
Corrections.
Public Health Nurse Quarterly.
Publications of the Russell Sage Foundation on Case Work.
Publications of the State and City Boards of Health.
See also under Modern Social Conditions, Survey of the
Nursing Field, etc.
INTRODUCTION TO LABORATORY WORK 155
Introduction to Laboratory Work (Elective)
TIME : 10 hours. Classes, conferences and laboratory work conducted by
a pathologist — an elective course given in the end of the Senior
year.
OBJECTS OF COURSE
1. One of the newer branches of work into which nurses are
going, is that of assistants to pathologists in hospital and
Board of Health laboratories, and routine pathological work
in physicians' offices. The short course here outlined would not
fit a nurse to assume any responsible position in this field, but
shouW give her an introduction to this form of work, and if
she shows unusual ability and interest in it, would probably
lead to further specialization after graduation,
2. Such a course would aim to give a greater facility in such
tests as may be required in any branch of nursing work (for
example simple urinal ysis), would make nurses more observ-
ant of abnormal conditions in their more responsible work with
patients outside the hospital, and would make them more in-
telligent and efficient assistants in all forms of experimental
and clinical work.
OUTLINE OF CLASSES
I. Introduction
Equipment, solutions, reagents. Laboratory rules and
methods.
II, III, and
IV. Urinalysis
Routine tests. Urinary sediments. Quantitative tests.
Relation to diets. Charting.
V. Feces
Routine tests. Parasites and Ova. Charting. Diets.
VI. Stomach Contents
Macroscopic and microscopic examination. Qualitative and
quantitative tests. Charting.
VII. Sputum
Macroscopic and microscopic examination. Carbol-fuchsin
and Gram's stains. Charting.
VIII and IX. Blood
Hemoglobin; counting corpuscles; smears, differential count-
ing. Blood cultures, blood pressure.
X. Body fluids
Transudates and exudates. Routine tests. Smears.
METHODS OF TEACHING
1. The greatest part of the course would be taught to small
groups by the demonstration and laboratory method. Stu-
dents who take this work should have a period of practical ex-
156 OUTLINES OF SUBJECTS
pericnce in the pathological laboratory, of from one to two
months, where they would be under the direct supervision of
the pathologist. Conferences and short papers will help in
mastering the principles and readings should be assigned in
current journals and reference books.
NOTE: In hospitals where special dietary investigation and
experimentation is being carried on, selected senior pupils may
be assigned to this form of laboratory service. In such a case
the course of study would deal with nutritional principles and
technic instead of the above. Nurses especially trained in this
branch of work are beginning to be in some demand. In Board
of Health work, the routine examination of water and milk
would be an important part of an assistant's duties.
EQUIPMENT AND ILLUSTRATIVE MATERIAL
Laboratory equipment — slides, pathological specimens
charts, etc.
TEXT AND REFERENCE BOOKS
Gibson: Chemical Laboratory Technic for Nurses.
Wells: Chemical Pathology.
Delafield and Prudden: Pathology.
Adami: Pathology.
Wood: Chemical and Microscopical Diagnosis.
See also under Pathology, Bacteriology, Medicine, etc.
APPENDIX I
Bibliography
The following list of books includes all those mentioned in the preceding
pages, with publishers, prices and dates of publication. It is suggested
that this list be used as a basis of selection for the Training School
Library.
Abbott, Grace: Women in Industry. Appleton. 1910. $2.50.
Adami, J. G., M.D. and Macrae, John, M.D.: Text Book on Pathology. Lea
& Febriger. 1914. $5.00.
Addams, Jane: A New Conscience and an Ancient Evil. Macmillan. 1912.
$1.00.
Addams, Jane: Social Ethics. Macmillan. 1902. $1.25.
Addams, Jane: The Spirit of Youth and the City Streets. Macmillan. 1909.
$1.25.
Addams, Jane: Twenty Years at Hull House. Macmillan. 1910. $2.00.
Amoss, H. L., M.D. : Chemistry for Nurses. Lea & Febriger. 1915. $1.50.
Antin, Mary: The Promised Land. Houghton-Mifflin. 1912. $2.00.
Asher, Phillip, M.D.: Chemistry and Toxicology for Nurses. Saunders.
1918. $1.50.
Bacon, Gorham, M.D.: Manual of Otology. Lea & Febriger. 1909. $2.25.
Balderston, L. Ray: Laundry Manual. (Authors own publication.) 1914.
$1.25.
Balderston, L. Ray: Housewifery. Lippincott. 1919. $2.00.
Bancroft, Jessie H. : Posture of School Children. Macmillan. 1913. $1.50.
Barrows and Lincoln: Home Science Cook Book. Whitcomb & Barrows.
1902. $1.00.
Baruch, Simon, M.D.: Principles and Practice of Hydro therapy. Wood.
1908. $4.00.
Barrus, Clara, M.D.: Nursing the Insane. Macmillan. 1908. $2.00.
Baskerville, Charles: Municipal Chemistry. McGraw-Hill Book Co. 1911.
•$5.00.
Bastedo, W. A., M.D.: Materia Medica and Therapeutics. Saunders. 1918.
$4.00.
Betts, G. H.: The Recitation. Houghton-Mifflin. 1911. .40.
Beers, Clifford W. : The Mind that Found Itself. Longmans, Green & Co.
1913. $1.50.
Berry, J. Me. W., M.D.: Orthopedic Surgery for Nurses. Saunders. 1916.
$1.00.
Berdoe, Edward: Origin and Growth of the Healing Art. Swan, Som-
merischen & Co. London. 1893.
Bigelow, Maurice A. and Anna M. : Applied Biology. Macmillan. 1911.
$1.40.
Bliss, Dr. M. R. and Olive, Prof. A. H.: Chemistry for Nurses. Lippincott.
1918. $1.59.
157
158 APPENDIX I
Blumgarten, A. S., M.D.: Materia Medica for Nurses. Macmillan. 1916.
$1.50.
Boardman, Mabel: Under the Red Cross Flag. Lippincott. 1918. $1.75.
Bolduan, Dr. C. F. and Grund, Marie: Applied Bacteriology for Nurses.
Saunders. 1916. $1.50.
Bradford, E. H!, M.D. and Lovett, R. W., M.D.: Treatise on Orthopedic
Surgery. Wood. 1915. $3.75.
Bridge, H. L.: Manual of Practical Nursing. Mosby. 1917. $1.00.
Broadhurst, Jean A.: Home and Community Hygiene. Lippincott. 1918.
$2.00.
Brown, Charlotte A.: The Junior Nurse. Lea & Febriger. (New edition in
preparation.) $1.00.
Brunton, T. L.: Lectures on the Action of Medicines. Macmillan. 1903.
$4.00.
Brubaker, A. P., M.D. : Anatomy and Physiology. Blakiston. 1916. $3.50.
Buchanan, Edith D. and Robert E.: Household Bacteriology. Macmillan.
1913. $2.40.
Bundy, Elizabeth: Anatomy and Physiology. Blakiston. 1916. $2.25.
Butler, Alfred M. : Household Physics. Whitcomb & Barrows. 1914. $1.30.
Byington, Margaret: What Social Workers should know about their own
Communities. Russell Sage Foundation. (Charity Organization De-
partment. Publications. 1916. .10.
Cabot, E. L.: Every Day Ethics. Holt. 1906. $1.36.
Cabot, Richard, M.D. : What Men Live By. Houghton-Mifflin. 1914. $1.65.
Cabot, Richard, M.D.: Social Service and the Art of Healing. Moffatt Yard
& Co. 1909. $1.35.
Cannon, W. B., M.D.: The Mechanical Factors in Digestion. Longmans,
Green & Co. (New edition in preparation.)
Cannon, W. B., M.D.: Bodily Changes in Pain, Hunger, Fear and Rage.
Appleton. 1915. $2.50.
Cannon, Ida M.: Hospital Social Service. Russell Sage Foundation. 1913.
$1.50.
Carey, H. W., M.D.: A Text-book for Nurses in Bacteriology. F. A. Davis
Co. 1915. $1.00.
Carter, H. S. and Howe, P. E. : Nutrition and Clinical Diet. Lea & Febriger.
1917. $5.50.
Campbell, H. C.: Household Economics. Putnam. 1896. $1.50.
Chapin, J. B.: Compendium of Insanity. Saunders. 1898 (out of print).
Chapin, C. V., M.D. The Sources and Modes of Infection. John Wiley.
1916. $3.50.
Chapin, R. C.: Standard of Living Among Workingmen's Families in New
York City. Russell Sage Foundation. 1909. $2.00.
Chapim, H. D., M.D. and Pisek, G. R., M.D.: Diseases of Infants and Chil-
dren. Wood. 1915. $3.50.
Chapin, H. D., M.D.: Theory and Practice of Infant Feeding. Wood. (Out
of print.)
Clouston, T. S., M.D.: Hygiene of the Mind. Dutton. 1907. $3.50.
BIBLIOGRAPHY 159
Colvin, S. S. and Bagley, W. C. : Human Behaviour. Macmillan. 1913. $1.00.
Conn, H. W.: Agricultural Bacteriology. Blakiston. 1918. $2.00.
Conn, H. W.: Bacteria, Yeasts and Moulds in the Home. Ginn & Co." 1917.
$1.20.
Cooke, J. B., M.D.: A Nurse's Handbook of Obstetrics. Lippincott. 1917.
$2.25.
Cooke, Sir Edward: Life of Florence Nightingale. 2 vols. Macmillan.
1914. $7.50.
Councilman, W. T., M.D.: Disease and its Causes. Home University Li-
brary. 1913. .60.
Cragin, E. B., M.D.: Essentials of Gynecology. Saunders. 1913. $1.25.
Crile, G. W., M.D.: Anoci-Association. Saunders. 1914. $3.00.
Crowell, Elizabeth: Tuberculosis Dispensary Method and Procedure. Nat.
Ass'n for the Study and Prevention of Tuberculosis. 1916. .25.
Curtis, C. C.: Nature and Development of Plants. Holt. 1907. $2.50.
Cyriax, E. G., M.D.: Kellgren's Manual Treatment. Wood. 1904. $4.00.
DaCosta, J. C., M.D. : Modern Surgery. General and Operative. Saunders.
1914. $6.00.
Davenport, C. B.: Heredity in Relation to Eugenics. Holt. 1911. $2.50.
Davis, G. G., M.D.: Principles and Practice of Bandaging. Blakiston.
1911. $1.00.
Davis, E. P., M.D.: Obstetric and Gynecologic Nursing. Saunders. 1917.
$2.00.
Davis, Michael M., and Warner, A. R.: Dispensaries. Macmillan. 1918.
•o 9c
$-..iO.
Dawson, Percy, M.D.: Anatomy and Physiology for Nurses. Macmillan.
1917. $1.75.
De Lee, J. B., M.D.: Obstetrics for Nurses. Saunders. 1917. $2.75.
Delafield, Francis, M.D. andPrudden, T.M., M.D. : Pathology. Wood. 1914.
$7.00.
Devine, Edward T.: Misery and its Causes. Macmillan. 1913. $1.25.
Devine, Edward T. : The Normal Life. McMurtrie. 1917. $1.15.
Devine, Edward T. : Principles of Relief. Macmillan. 1904. $2.00.
Despard, L. L. : Text-Book of Massage. Hodder & Stoughton. 1914. $4.00.
Dewey, John and Tufts, J. H. : Ethics. Holt. 1908. $2.25.
Dewey, John: How We Think. Heath. 1910. $1.28.
De Witt, Katherine: Private Duty Nursing. Lippincott. 1917. $1.75.
Doane, R. W.: Insects and Disease. Holt. 1910. $2.00.
Dock, Lavinia L.: Materia Medica for Nurses. Putnam. 1916. $1.50.
Dock, Lavinia L. : Hygiene and Morality. Putnam. 1912. $1.25.
Doty, Alvah H.: Prompt Aid to the Injured. Appleton. 1912. $1.75.
Dubois, Paul: The Education of Self. Funk & Wagnalls. 1914. $1.50.
Dubois, Paul: The Influence of the Mind on the Body. Funk & Wagnalls. $.50.
Dunton, W. R., M.D. : Reconstruction Therapy. Saunders. 1919. $1.50.
Dunton, W. R., M.D.: Occupation Therapy. Saunders. 1915. $1.50.
Eliason, E. L., M.D.: Practical Bandaging. Lippincott. 1914. $4.50.
Eliason, E. L., M.D.: First Aid in Emergencies. Lippincott. 1914. $1.50.
Ellwood, C. A. : Sociology and Modern Social Problems. American Book Co.
1913. $1.00.
160 APPENDIX I
Ellis, Havelock: Task of Social Hygiene. Hough ton-Mifflin. $2.75.
Emerson, C. P., M.D.: Essentials of Medicine. Lippincott. 1918. $2.50.
Emerson, Ralph Waldo: Essays. Hough ton-Mifflin. (Cambridge Classics).
$1.35.
Encyclopedia Britannica. : University Press. 1914. 28vol. $126.00.
Epler, Percy H.: Life of Clara Barton. Macmillan. 1915. $1.75.
Farmer, F. M.: Foods and Cookery for the Sick and Convalescent. Little,
Brown & Co. 1912. $1.75.
Farmer, F. M.: Boston Cook Book. Little, Brown & Co. 1914. $2.00.
Farr, C. B.: Internal Medicine. Lea & Febriger, 1913. $2.00.
Fisher, Irving and Fiske, E. L., M.D.: How to Live. Funk & Wagnalls.
1916. $1.00.
Foley, Edna: Visiting Nurse Manual. Chicago Visiting Nurse Association.
1915. .25.
Foote, John, M.D.: Essentials of Materia Medica and Therapeutics for
Nurses. Lippincott. 1918. $1.75.
Fowler, R. S., M.D. : The Operating Room and the Patient. Saunders. 1913.
$3.56.
Fox, Herbert, M.D. : Bacteriology and Protozoology. Lea & Febriger. 1916.
$1.50.
Friedenwald and Rurah: Dietetics for Nurses. Saunders. 1917. $1.50.
Gailbraith, Anna M., M.D.: Hygiene and Physical Culture for Women.
Saunders. 1917. $2.25.
Gardner, Mary S.: Public Health Nursing. Macrnillan. 1915. SI .75.
Gerrish. F. R. M.D.: Anatomy. Lea & Febriger. 1902. $6.50.
Gibbs, Winifred: Lessons in Feeding the Family. N. Y. Ass'n for Improving
the Condition of the Poor. 1915. .25.
Gibson, Anna: Clinical Laboratory Technic. Whitcomb & Barrows. 1918.
$1.25.
Goldmark, Josephine: Fatigue and Efficiency. Russell Sage Foundation.
1912. $4.00.
Gray: Anatomy. Lea & Febriger. (20th edition.) 1918. $7.50.
Graham, Douglas, M.D.: Massage. Lippincott. 1913. $5.00.
Grulee, C. L., M.D.: Infant Feeding. Saunders. 1917. $3.25.
Gulick, L. H. and Ayres, L. P.: Medical Inspection in Schools. Russell Sage
Foundation. 1913. $1.50.
Hall, W. S., M.D.: Nutrition and Dietetics. Appleton. 1913. $2.25.
Hall, Dr. H. L. and Buck, Mettice C.: The Work of Our Hands. Moffatt,
Yard & Co. 1915. $1.50.
Halliburton, W. D., M.D.: Hand-book of Physiology. Blakiston. 1917.
$3.50.
Hare, H. A., M.D.: Practical Therapeutics. Lea & Febriger. 1918. $4.75.
Hcaley, Wm.: The Individual Delinquent. Little, Brown& Co. 1915. $5.00.
Henderson, C. R.: Dependents, Defectives and Delinquents. Heath. 1901.
$2.00.
Henry, J. N., M.D.: A Nurse's Hand-book of Medicine. Lippincott. 1913..
$2.00.
BIBLIOGRAPHY 161r
Hertar, C. A.: Biological Aspects of Human Problems. Macmillan. 1911.
$1.50.
Hill, Charles, M.D.: Histology. Saunders. 1914. $2.25.
Hill, Charles, M.D.: The New Public Health. Macmillan. 1916. $1.25.
Hinsdale, Guy, M.D.: Hydrotherapy. Saunders. 1910. $3.50.
Hiss, Dr. P. H. and Zinnser, Dr. Hans: A Text-Book on Bacteriology. Ap-
pleton. 1918. $3.75.
Hopkins, W. B., M.D.: The Roller Bandage. Lippincott. 1911. $1.50.
Hollander, Bernard, M.D.: Nervous Women. Button. 1916. $1.50.
Holt, L. Emmet, M.D.: Diseases of Infancy and Childhood. Appleton.
1918. $6.50.
Holt, L. Emmet, M.D.: The Care and Feeding of Children. Appleton. 1918.
.85.
Hough, Theodore and Sedgwick, W. T.: Human Mechanism. Ginn & Co.
1918. $2.00.
Howell, C. H., M.D.: Surgical Nursing and Hospital Technique. Columbus
Pub. Co. 1913. $5.00.
Howell, W. H., M.D.: Text-Book of Physiology. Saunders. 1918. $5.00.
Hughes, D. E., M.D.: Practice of Medicine. Blakiston. 1917. $3.25.
Hunter, Robert: Poverty. Macmillan. 1904. $1.50.
Jackson, G. T., M.D.: Diseases of the Skin. Lea & Febriger. 1914. $3.00.
Jaffa: Standard Dietary for an Orphanage. (Bulletin) California State
Board of Charities. 1915.
James, William: Talks to Teachers. Holt. 1899. $1.50.
James, William: Psychology (Briefer Course). Holt. 1892. $1.75.
Jordan, E. O.: General Bacteriology. Saunders. 1918. $3.75.
Kelley, Florence: Modern Industry. Longmans, Green & Co. (temporarily
out of print).
Kelly, H. A., M.D. : Medical Gynecology. Appleton. 1912. $6.50.
Kelly, H. A., M.D.: Operative Gynecology. Appleton. 1918. $16.00.
Kellogg, J. H., M.D.: Rational Hydrotherapy. Modern Medicine Pub. Co.
1918. $7.50.
Kerley, C. G., M.D.: Practice of Pediatrics. Saunders. 1918. $6.50.
Kimber, Diana C.: Anatomy and Physiology. Macmillan. 1918. $2.60.
Kinne and Cooley: Shelter and Clothing. Macmillan. 1913. $1.10.
Kingsbury, Susan: Vocations for the Trained Woman. Longmans, Green &
Co. 1910. $1.50.
Kinnicutt, Winslow and Pratt: Sew age Disposal. Wiley & Son. 1916. $3.00.
Kirkpatrick, E. A. : Child Study. Macmillan. 1917. $1.30.
Kittredge, Mabel H. : Practical Home Making. Century Co. 1917. .60.
Knopf, S. A.: Tuberculosis as a Curable and Preventable Disease. Moffatt,
Yard & Co. 1909. $2.25.
Kober, G. M.: Industrial and Personal Hygiene. President's Homes Com-
mission. Washington. 1908.
Kraeplin, Emil, M.D.: Clinical Psychiatry. Vol. 111. Wood. 1917. $3.50.
Lacroix: Military and Religious Life in the Middle Ages. Chapman & Hall.
London.
162 APPENDIX I
Langworthy: Food Customs and Diet in American Homes. U. S. Dept. of
Agriculture. Bulletin 110.
La Motte, Ellen N.: Tuberculosis Nursing. Putnam. 1915. $1.50.
Latimer, Caroline W., M.D.: Girl and Woman. Appleton. 1909. $1.75.
Lee, F. S., M.D.: Scientific Features of Modern Medicine. Lemcke. 1911.
$1.50.
Lee, Roger I.: Health and Disease. Little, Brown & Co. 1917. $2.00.
Lee, Joseph: Play in Education. Macmillan. 1915. $1.50.
Loch, C. S.: Charity and Social Life. Macmillan. 1910. $2.00.
Lounsbury, H. C.: Making Good on Private Duty. Appleton. 1912. $1.25.
Lovett, R. \V., M.D.: Lateral Curvature of the Spine and Round Shoulders.
Blakiston. 1916. $1.75.
Lynch, Lt. Col. Charles: Red Cross Text-Book on First Aid and Relief Col-
umns. Blakiston. 1918. $1.00.
Lynde, C. J. : Household Physics. Macmillan. 1904. SI. 25.
MacFarlane, Catherine, M.D.: Gynecology for Nurses. Saunders. 1913.
$1.25.
Mackenzie, W. L.: Health and Disease. Home University Library. 1911.
.75.
Mackenzie. J. S. : Manual of Ethics. Hinds, Noble & Eldridge. 1901. S1.50.
Mackenzie, James: Symptoms and their Interpretation. Chicago Med.
Book Co. 1909. $3.00.
MacPherson, Wm. and Henderson, W. E.: Elementary Study of Chemistry.
Ginn & Co. 1917. $1.60.
Marshall, A. M.: Vertebrate Embryology. Putnam. 1893. $6.00.
Marshall, C. E.: Microbiology. Blakiston. 1917. $3.00.
Martin, H. N.: Human Body. Holt. 1917. S3.00.
Maxwell, Anna C. and Pope, Amy E.: Practical Nursing. Putnam. 1914.
$2.00.
May, C. H., M.D.: Diseases of the Eye. Wood. 1917. $2.50.
McCollurn, E. V. : The Newer Knowledge of Nutrition. Macmillan. 1918.
$1.50.
McCombs, R. S., M.D.: Diseases of Children for Nurses. Saunders. 1916.
$2.00.
McCunn, John: Making of Character. Macmillan. 1910. $1.25.
McDougall, Wm. Social Psychology. Luce & Co. 1909. $1.50.
McTsaac, Isabel: Primary Nursing Technique. Macmillan. 1907. $1.25.
McKenzie, R. T., M.D.: Exercise in Education and Medicine. Saunders.
1915. $1.00.
McNutt. J. S. : Manual for Health Officers. Wiley & Sons. 1915. $3.00.
McMurry, F. M.: How to Study. Houghton-Mifflin. 1909. $1.50.
Meachen, G. Norman: Diseases of the Skin for Nurses. (English Importa-
tion). Chicago Mcd. Book Co. $1.25.
Miller, Irving, E.: Psychology of Thinking. Macmillan. 1909. $1.25.
Mitchell, J. L., M.D., and Guliok, Luther, M.D.: Mechano Therapy and
Physical Education. Blakiston. $300.
Morley, Edith J. (Editor): Women Workers in Seven Professions. Dutton.
1911 $2.50.
BIBLIOGRAPHY 163
Morse, J. L., M.D.: Care and Feeding of Children. Harvard University
Press. 1914. $.50.
Morse, J. L., M.D., and Talbot, F. B., M.D. : Diseases of Nutrition and Infant
Feeding. Macmillan. 1915. $3.00.
Morrow, A. S., M.D.: Immediate Care of the Injured. Saunders. 1917.
$2.75.
Morrow, Prince A., M.D.: Social Diseases and Marriage. Lea Bros. 1904.
$3.00.
Mozans, H. J.: Women in Science. Appleton. 1915. $2.50.
Mullerheim: Die Wochenstube in der Kunst. F. Enke, Stuttgart. 1904.
Munsterberg, Hugo : Psychotherapy . Moffatt, Yard & Co. 1909. $2.25.
Nearing, Scott: Financing the Wage Earner's Family. Huebsch. 1914.
$1.25.
Nesbitt, Florence : Low Cost Cooking. American School of Home Economics,
Chicago. 1915. $.50.
Newsholme, A., M.D.: The Prevention of Tuberculosis. Dutton. 1916.
$3.50.
Nightingale, Florence : Notes on Nursing. Appleton. 1917. (Last printing).
$.85.
Nightingale, Florence: Talks to Pupils. A selection of addresses to proba-
tioners and nurses. Macmillan. London. 1914.
Nutting, M. Adelaide : Educational Status of Nursing. Bureau of Education.
Washington.
Nutting, M. Adelaide, and Dock, Lavinia L.: History of Nursing. 4 vols.
Putnam. Vols. I-II, 1907, $5.00; Vols. III-IV, 1912, $5.00.
Oliver, Thomas, M.D.: Diseases of Occupation. Dutton. 1917. $4.00.
Osier, William, M.D. : Practice of Medicine. Appleton. 1916. $6.00.
Osier, William, M.D.: An Alabama Student and Other Essays. Oxford
University Press. 1908. $2.00.
Osier, William. M.D.: Aequanimitas. Blakiston. 1906. $2.25.
Otis, E. D.: The Great White Plague. Crowell. 1909. $1.00.
Paget, Stephen: Confessio Medici. Macmillan. 1908. $1.25.
Palmer, Margaret D.: Lessons on Massage. Wood. 1908. $3.50.
Palmer, G. H.: The Teacher. Houghton-Mifflin. 1908. $1.75.
Parker, S. C.: Methods of Teaching in High Schools. Ginn & Co. 1915.
$1.80.
Parker, Linette A.: Materia Medica. Lea & Febriger. 1916. $1.75.
Parker, E. M., M.D., and Breckinridge, S. D., M.D.: Surgical and Gynecolog-
ical Nursing. Lippincott. 1916. $2.50.
Parker, W. H., M.D., and Williams, Anna, M.D.: Pathogenic Micro-
organisms. Lea & Febriger. 1918. $4.75.
Parker, T. J., and Haswell, W. A.: Text-book of Zoology. 2 vols. Macmillan.
1910. $9.00.
Parloa, Maria: Home Economics. Century Co. 1906. $1.50.
Parsons, Sara E. : Nursing Problems and Obligations. Whitcomb & Barrows.
1916. $1.00.
Pattee, Alida F. : Practical Dietetics. Whitcomb & Barrows. 1917. $1.75.
164 APPENDIX I
Paul, G. P., M.D.: Nursing in the Acute Infectious Fevers. Saunders. 1915.
$1.00.
Perkins, Agnes F.: Vocations for Trained Women. Longmans, Green & Co.
1911. $1.20.
Piersol, G. A., M.D.: Normal Histology. Lippincott. 1916. $3.50.
Pillsbury, W. B.: Essentials of Psychology. Macmillan. 1911. $1.25.
Polak, J. O., M.D. : Manual of Obstetrics. Appleton. 1913. $3.00.
Pope, Amy E. : Anatomy and Physiology for Nurses. Putnam. 1917. $2.00.
Pope. Amy E.: Physics and Chemistry for Nurses. Putnam. 1918. $2.00.
Pope, A. E., and Carpenter, M. T. : Essential of Dietetics. Putnam. 1917.
$1.25.
Potts, C. S., M.D.: Electricity in Medicine and Surgery. Lea & Febriger.
1911. $4.75.
Price, G. M.: Hygiene and Sanitation for Nurses. Lea & Febriger. 1917.
$1.75.
Priestman, Mabel T.: Art and Economy in Home Decoration. John Lane &
Co. 1908. $1.00.
Putnam, J. P.: Plumbing and Household Sanitation. Doubleday, Page &
Co. 1913. $3.75.
Putnam, Mrs. Geo. Haven: The Lady. Sturgis & Walton. $1.25.
Pyle, W. L., M.D. : Personal Hygiene. Saunders. 1918. $1.75.
Ramsey, W. R., M.D.: Care and Feeding of Infants and Children. Lippin-
cott. 1916. $2.00.
Register, W. R., M.D : Practical Fever Nursing. Saunders. 1907. $2.50.
Ribot, T. A. : Diseases of the Personality. Boericke & Tafel. 1909. $1.00.
Ribot, T. A. : Diseases of the Will. Open Court Pub. Co. 1903. $.75.
Richards, Ellen H.: Home Sanitation in Daily Life. Whitcomb & Barrows.
1907. $.60.
Richards, Ellen H.: Euthenics. Whitcomb & Barrows. 1910. $1.00.
Richmond, Mary: Social Diagnosis. Russell Sage Foundation 1916. $1.75.
Richer: L'Art et la Medicene. Gaultier, Magnier et Cie. Paris. 1902.
Robb, Isabel Hampton: Nursing Principles and Practice. Koeckert. 1917.
$1.75.
Robb, Isabel Hampton: Ethics of Nursing. Koeckert. 1917. $1.50.
Robb, Isabel Hampton: Educational Standards for Nurses. Koeckert. 1907.
$1.25.
Robb, Hunter, M.D. : Aseptic Surgical Technic. Lippincott. 1916. $2.50.
Roberts, J. G.: Bacteriology and Pathology. Saunders. 1916. $1.50.
Robinson and Breasted: Outlines of European History. Ginn & Co. $1.75.
Roger, George E. H. : Principles of Medical Pathology. Appleton. 1903.
(Out of print.)
Rosenau, M. J., M.D.: Preventive Medicine and Hygiene. Appleton. 1918
$6.50.
Rose, W. R., and Carless, Albert: Manual of Surgery. Wood. 1917. $7.00.
Rose, Mary S.: Feeding the Family. Macmillan. 1916. $2.10.
Rose, Mary S. : Food for School Boys and Girls. (Bulletin) Teachers College.
Columbia Univ. Series No. 10.
Rose, Mary S. : Cost of Food. Cornell Bulletin. Food Series No. 7.
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Rose, Mary S. Handbook of Laboratory Dietetics. Macmillan. 1912.
$1.10.
Ross, Edward A. : Social Psychology. Macmillan. 1908. $1.50.
Sabotta-McMurrich: Atlas and Text-book of Human Anatomy. Saunders.
(Out of print.)
Sainsbury, Harrington: Drugs and the Drug Habit. Dutton. 1909. $3.50.
Sanders, Georgina J. : Modern Methods in Nursing. 1916. $2.50.
Saleeby, C. W.: Surgery and Society. Moffatt, Yard & Co. 1912. $2.50.
Schreiner, Olive: Woman and Labor. Stokes. 1911. $1.25.
Seager, Henry: Social Insurance. Macmillan. 1910. $1.00.
Sedgwick, W. T. : Principles of Sanitary Science and Public Health. Macmil-
lan. 1902. $3.00.
Senn, Nicholas, M.D.: Operating-Room Technic. Chicago Med. Book Co.
1905. $1.75.
Sherman, H. C.: Chemistry of Food and Nutrition. Macmillan. 1918.
$2.00.
Snedden, F. H.: Problem of Vocational Education. Houghton, Mifflin.
1910. $.40.
Slemons, J. M., M.D.: Prospective Mother. Appleton. 1912. $1.75.
Smith, Richard M. and Mrs. H. Greene : Baby's First Two Years. Houghton-
Mifflin. 1915. $.85.
Smith, Amy Armour: The Operating Room. Saunders. 1916. $1.50.
Sollmann, Torald. M.D.: Text-book of Pharmacology. Saunders. 1917.
$1.50.
Starling, E. A.: Principles of Human Physiology. Lea & Febriger. 1915.
$6.00.
Starr, Louis, M.D.: Hygiene of the Nursery. Blakiston. 1913. $1.00.
Stevens, A. A. : Practice of Medicine. Saunders. 1915. $3.00.
Stevens, A. A., M.D.: Materia Medica and Therapeutics. Saunders. 1909.
$3.50.
Steiner, E. A.: Ebb and Flow of the Immigrant Tide. Revell. 1909. $1.50.
Steiner, G. A.: On the Trail of the Immigrant. Revell. 1909. $1.50.
Stelwagon, H. W., M.D.: Diseases of the Skin. Saunders. 1916. $6.50.
Stiles, P. G.: Nutritional Physiology. Saunders. 1918. $1.50.
Stimson, Julia: Nurses Handbook of Drugs and Solutions. Whitcomb & Bar-
rows. 1915. $1.00.
Strayer, Geo. G., and Norsworthy, Naomi: How to Teach. Macmillan.
1917. $1.40.
Streightoff, F. H.: Standard of Living. Houghton-Mifflin. 1911. $1.25.
Struthers, Lina Rogers: School Nursing. Putnam. 1917. $1.75.
Taylor, F. W.: Shop Management. Harper Bros. 1911. $1.50.
Terrill, Bertha M. : Household Management. Am. School of Home Economics.
1910. $1.00.
Tiffany, Rev. Francis: Life of Dorothea Lynde Dix. Houghton-Mifflin.
1890. $1.75.
Tigerstedt, R. A., M.D.: Text Book of Physiology. Appleton. 1916. $4.50.
Thompson, W. Oilman, M.D.: Practical Dietetics. Appleton. 1909. $5.50.
166 APPENDIX I
Thompson, W. Oilman, M.D.: Occupational Diseases. Appleton. 1914.
$6.50.
Thorndike, E. L.: Individuality. Houghton-Miffiin. 1917. $.40.
Thorndike, E. L. : Principles of Teaching, Based on Psychology. Seller.
1906. $1.25.
Thorndike, E. L. Elements of Psychology. Seiler. 1907. $1.50.
Thorndike: Orthopedic Surgery. Blakiston. (Out of print.)
Tooley, Sarah: History of Nursing in the British Empire. Cassell. London.
Tracy, Susan E. : Invalid Occupations. Whitcomb & Barrows. 1910. $1.50.
Tracy, Susan E. : Rake Knitting. Whitcomb & Barrows. 1916. $ .25.
Tubby, A. H.: Deformities. 2 vols. Macmillan. 1912. (Imported to order
only.) $16.00.
Tuker and Malleson: Handbook to Christian and Ecclesiastical Rome. Mac-
millan. 1897. $2.75.
Tyler, J. M.: Growth and Education. Houghton-Miffiin. 1907. $1.50.
Vulte, H. T.: Household Chemistry. Chemical Publishing Co. 1917. $1.50.
Veiller, Lawrence: Housing Reforms. Russell Sage Foundation. 1910.
$2.00.
Waters, Yssabella: Visiting Nursing in the United States. Russell Sage
Foundation. 1912. $1.25.
Wells, H. G. : Chemical Pathology. Saunders. 1918. $4.25.
West, (Mrs. Max) : Care of Children. (Pamphlet) Children's Bureau. Wash-
ington, D. C.
West, (Mrs. Max) : Prenatal Care. (Pamphlet) Children's Bureau. Washing-
ton.
Wharton, H. R.: Minor Surgery and Bandaging. Lea and Febiger. 1913.
$2.00.
Wheeler, Mary C. : Nursing Technique. Lippincott. 1918. $1.50.
Whipple, G. M.: How to Study Effectually. Public School Pub. Co. 1916.
$.50.
White, W. A., M.D.: Outlines of Psychiatry. Nervous and Mental Disease
Pub. Co. Washington, D. C. $3.00.
White, W. A., M.D.: Principles of Mental Hygiene. Macmillan. 1917.
$2.00.
Wiedersheim: Comparative Anatomy. Macmillan. (Out of print.)
Williams, J. W., M.D.: Obstetrics. Appleton. 1917. $2.00.
Wilcox, R. W., M.D. : A Manual of Fever Nursing. Blakiston. 1908. $1.00.
Wilson, J. C., M.D.: Fever Nursing. Lippincott. 1915. $1.50.
Withington, Edward T.: Medical History from the Earliest Times. London.
1894.
Wood, F. C., M.D. : Chemical and Microscopical Diagnosis. Appleton. 1917.
$5.50.
Zinnser, Hans: Infection and Resistance. Macmillan. 1918. $4.25.
Zangwill, Israel: The Melting Pot. Macmillan. 1914. $1.50.
APPENDIX II
Inexpensive and Free Bulletins, Pamphlets and Reports for use in teach-
ing nurses, may be secured by writing to the following organizations, bureaus
and firms. By explaining the purpose for which it is to be used, much of this
literature can be secured in quantities for distribution.
American Association for Conservation of Life, 1 Madison Avenue, New
York City.
American Association for Labor Legislation, 131 E. 23d Street, New York
City.
American Association of Societies for Organizing Charity, 105 East 22d Street,
New York City.
American Association for Study and Prevention of Infant Mortality, 1211
Cathedral Street, Baltimore, Md.
American Home Economics Association, Roland Park, Baltimore, Md.
American Posture League, 1 Madison Avenue, New York City.
American Public Health Association, 126 Massachusetts Avenue, Boston,
Mass.
American Red Cross, Washington, D. C.
American Social Hygiene Association, 105 West 40th Street, New York City.
American Society for Control of Cancer, 25 West 45th Street, New York City.
American Medical Association, 525 North Dearborn Street, Chicago, 111.
Association for Improving the Condition of the Poor, 105 East 22d Street,
New York City.
Association of Tuberculosis Clinics, 105 East 22d Street, New York City.
Cornell University, Ithaca, N. Y. (Bulletins for Farmers' Wives.)
Children's Bureau, Department of Labor, Washingon, D. C. (Pamphlets
on Prenatal and Child Care, etc.)
Departments of Health — State and City. (Weekly, Monthly and Special
Bulletins and Reports.)
Fairchild Foster and Bro., New York City. (Diet Slips.)
General Electric Company, Cleveland, Ohio. (Pamphlet on First Aid.)
Health Education League, 18 Beacon Street, Boston, Mass. (24 popular
pamphlets on Hygiene and Sanitation.)
Housekeeping Experiment Station, 28 Hoyt Street, Stamford, Conn. (Pam-
phlets on Efficiency and Household Management.)
International Child Welfare League, 70 Fifth Avenue, New York City.
Joint Committee on Prison Reform, 105 West 40th Street, New York City.
Life Extension Institute, 25 West 45th Street, New York City.
Massachusetts Society for Mental Hygiene, 15 Ashburton Place, Boston,
Mass.
Metropolitan Life Insurance Co., New York City. (Pamphlets on Hygiene,
first aid, etc.)
National Association for Study and Prevention of Tuberculosis, 105 East
22d Street, New York City.
167
168 APPENDIX II
National Child Labor Committee, 105 East 22d Street, New York City.
National Child Welfare Exhibit Association, 70 Fifth Avenue, New York City.
National Civic Federation, 1 Madison Avenue, New York City.
National Committee on Mental Hygiene, 50 Union Square, New York City.
National Committee for Prevention of Blindness, 130 East 22d Street, New
York City. (Pamphlets and posters.)
National Conference of Charities and Corrections, 315 Plymouth Court,
Chicago, 111.
National Consumers' League, 105 East 22d Street, New York City.
National Organization of Public Health Nursing, 156 Fifth Avenue, New
York City.
National Housewives' League, 25 West 45th Street, New York City.
New York Committee on the Prevention of Blindness, 105 East 22d Street,
New York City.
New York School of Philanthropy, 105 East 22d Street, New York City.
(Pamphlets on Social Work.)
Russell Sage Foundation, 130 East 22d Street, New York City. (Bulletins
on Education and Social Welfare.)
Rockefeller Foundation, 66th Street and Avenue A., New York City. (Bulle-
tins on Medical Research.)
Teachers College, Columbia University, New York City, (Technical Edu-
cation Bulletins on Nutrition, Diet, Clothing, Etc., including "Anno-
tated list of text and reference books for Training Schools for Nurses,"
and "Opportunities in the Field of Nursing.")
U. S. Bureau of Education, Washington, D. C. (Bulletins on Education,
Medical Inspection, Rural Problems, etc., including "Educational Status
of Nursing.")
U. S. Department of Agriculture, Washington, D. C. (Bulletins on Foods,
Food Adulteration, Food Preparation, Household Pests, Disinfectants,
etc.)
U. S. Department of Labor, Washington, D. C. (Bulletins on Industrial
Conditions, Safety, Industrial Poisons, Fatigue, etc.)
U. S. Public Health Service, Washington, D. C. (Bulletins on Sanitation,
Preventive Medicine, Infectious Diseases, etc.)
See also list of firms supplying equipment and illustrative material.
APPENDIX III
Some Firms Supplying Equipment and Illustrative Material of Use in
Schools of Nursing. Sample exhibits from commercial firms can sometimes
be secured free if it is understood that they are to be used for educational
purposes.
American Red Cross, First Aid Dept., Washington, D. C. (Charts and First
Aid Outfits.)
American Social Hygiene Association. 105 W. 40th Street, New York City.
(Series of colored posters on social hygiene. May be sent as loan exhibit
on request.)
American Posture League. 1 Madison Avenue, New York. (Charts on Pos-
ture.)
Arnold, E. J. and Son, Leeds, England. (Food Charts.)
Baker and Company, 159 Franklin Street, New York. (Sample exhibit,
cocoa and chocolate, crude materials and preparations.)
Bausch and Lomb. Rochester, N. Y. (Microscopes, Lanterns, etc.)
Berlin Photographic Company. New York. (Prints and Photographs.)
Betz, Frank S. and Company. Hammond, Ind. (Hospital and Laboratory
Supplies.)
Bridgman, E.G. 86 Warren Street, New York. (Beef Chart.)
Burnett, Joseph and Company. Boston, Mass. (Samples of vanilla bean
and pamphlet.)
Caxton School Supply Company, Chicago, 111. (Blackboards, Erasers, etc.)
Chase, M. J. Pawtucket, R. I. (Hospital Doll or Model.)
Colgate and Company. New York. (Samples of Soaps, Talcum Powders,
etc., with Pamphlets.)
Cosmos Picture Company. New York. (Inexpensive Prints.)
Curtis and Cameron. Boston, Mass. (Copley Prints.)
Educational Equipment Company, 70 Fifth Avenue, New York City. (School
and College Outfitters.)
Educational Exhibition Company. Providence, R. I. (Material for graphic
presentation of facts.)
Eimer and Amend. 205 3d Avenue, New York. (Laboratory Equipment.)
First Aid Equipment Company. New York. (First Aid Outfits.)
Coder, Heinman Company. Chicago, 111. (Charts and Models.)
Hammond Attilliers. Chicago, 111. (Specimens, Skeletons, Models, etc.)
Harvard Apparatus Company. Cambridge, Mass. (Scientific Laboratory
Supplies.)
Hecker Milling Company. New York. (Educational Exhibit of Flour and
Cereals.)
Huyler's. 64 Irving Place, New York. (Educational Exhibit Cocoa, Choco-
late, etc., and Charts.)
Johnson and Johnson. New Brunswick, N. J. (Surgical Materials, First
Aid Cabinets with booklets on First Aid.)
169
170 APPENDIX III
Knott Apparatus Company. Boston, Mass. (Bacteriological and Patho-
logical Supplies.)
Kny Scheerer Company. New York. (Hospital Supplies, Models, Skele-
tons, Microscopes, Slides, and Laboratory Equipment.)
Lippincott Company. Philadelphia, Pa. (Piersol Anatomical Charts.)
Louis Company, O. T., 59th Street and 5th Avenue, New York. (Mannikins,
Laboratory Equipment, etc.)
Lowney's. Boston, Mass. (Educational Exhibit, Chocolate, Cocoa, etc.)
Mclntosh Stereoptican Company. Chicago, 111. (Lantern Slides.)
Museum of Natural History. New York. (Slides, Cultures, etc.)
National Child Welfare Exhibit Association. 70 Fifth Avenue, New York
City. (Series of 25 colored Posters on Baby Welfare.)
Nystrom and Company. 623 South Wabash Avenue. Chicago, 111. (Charts,
Skeletons, Models, etc. Agents for W. and A. K. Johnston's and the
Frohse Charts.)
Parke, Davis and Company. Detroit, Mich. (Drugs, Cabinets of Crude
Drugs, etc.)
Postum Cereal Company. Battle Creek, Mich. (Postum, Cereal Exhibit —
Free.)
Proctor Gamble Company. Cincinnati, Ohio. (Laundry Materials. Sam-
ples of Soaps, Starches, etc., and pamphlet on Laundering.)
Royal Baking Powder Company. 135 William Street, New York. (Sam-
ples showing composition of Baking Powder, Free.)
Scientific Instrument Company. Chicago, 111. (Laboratory Supplies.)
Sheldon, E. H., and Company. Muskegon, Mich. (Laboratory Tables for
Cooking, Physics, Biology, Chemistry, etc.)
Spencer Lens Company. Buffalo, N. Y. (Microscopes, Delineascopes.)
Stickney and Poor Spice Company. Boston, Mass. (Sample Case of Spices.)
U. S. Depart, of Agriculture. Washington, D. C. (Charts on Metric System,
Food Composition and Values and Measuring Systems.)
U. S. Public Health Service. Washington, D. C. (Stereopticon Loan Li-
brary on Public Health Subjects.)
Ward Natural Science Establishment. Rochester, N. Y. (Skeletons, Cul-
tures, Slides, etc.)
Washburn and Crosby. Minneapolis, Minn. (Samples of Food Stuffs.
Free.)
Whitcomb and Barrows. Huntington Chambers, Boston, Mass. (Food
Charts.)
Women's Home Companion. 381 Fourth Avenue, New York. (Baby Charts
and Bulletins from Better Babies Bureau.)
Worcester Salt Company. New York. (Salt Samples and booklet.)
APPENDIX IV
Physical Exercises
A few suggestions for simple exercises which are designed especially to
meet the needs of nurses. May be given early in the course in connection
with classes in Hygiene or independently.
General Exercise
1. Take good standing position. Hands to shoulders, elbows
bent. Extend arms slowly sideways and bend knees. Bring
arms to shoulders and straighten knees.
2. Standing erect. Hands on hips. Draw head slowly
backward horizontally, keeping chin drawn in.
3. Standing erect. Place hands on top of head. Stretch
body upward as far as possible keeping heels on the floor;
extend arms upward, then press arms slowly sideways down-
ward to side of the body (hands facing floor) .
4. Standing erect. Hands on hips. Bend trunk forward
from hips, keeping the back flat. Do not curve the back.
5. Standing erect. Arms extended sideways. Bend trunk
to each side.
(Exercise to be done from 8-10 times each.)
Exercises for Posture and Walking
1. Practice standing erect, as tall as possible without strain
and without hollowing the back. Abdomen drawn in, waist
muscles firm; head easily poised, and arms hanging freely at
sides. Relax body then take position time after time, till
habit of correct posture is established.
2. Take posture as in 1. Raise arms slowly sideways to
horizontal and raise heels. Chest high.
3. Position as in 1. Hands on hips. Place one foot forward —
sway weight of body to forward foot, by lifting the backward
heel.
4. Position as in 1. Hands on hips. Sway body backward,
forward, and to each side, keeping good posture.
5. In walking let weight fall on the ball of the foot, turn
toes straight ahead, and preserve spring.
Breathing Exercises
1. Standing. Arm raising sideways with deep inspiration.
Return to first position with expiration (8-10 times.)
2. Standing. Raise arms slowly forward upward, allowing
hands to droop, keeping them close to the body, till extended
above the head. Deep inspiration. Return to first position
sinking slowly sideways. Expiration. (5-8 times.)
3. Standing. Arms extended sideways. Rotate arms in
large circles and breathe deeply. (8-10 times.)
171
172 APPENDIX IV
4. Lie on the back' — hands behind the neck — knees slightly
bent— feet on floor. Practice taking long, deep breaths to
establish a longer deeper rhythm.
Exercises for Arms
Sitting Erect.
1. Arms extended upward, hands clenched. Draw arms
slowly and forcibly downward, as though pulling heavy weight.
Extend upward without force.
2. Hands at shoulders. Push forcibly upward, as though
lifting heavy weight, and return to first position without force.
3. Hands at shoulders. Extend arms slowly and forcibly
sideways.
(Each exercise 5-10 times.)
Exercises for Legs and Feet
Position— standing erect.
1. Hands on hips. Heel raising.
2. Hands on hips. Alternate heel raising and toe raising.
3. Hands on hips. Bend knee upward to right angles with
the body. Stand firmly on opposite foot.
(Each exercise 10-15 times.)
Position with feet parallel or slightly turned in.
1. Raise on toes; bring heels to floor again rolling slightly
on outer borders of feet. (10-20 times.)
2. Roll feet on outer borders. (15-20 times.)
3. Walk on outer borders of feet with toes turned in.
4. Sitting. Raise arches by drawing toes toward heels,
keeping both toes and heels on floor. (Valuable because it
may be done indefinitely with shoes on.
Exercises for Constipation
1. Lie on back — knees bent— feet on floor. Draw knees to
chest, making pressure on abdomen. Very slowly. (8-10
times.)
2. Lie on back' — legs extended. Draw knees upward rolling
toward right swing knees in circle across to left side, keeping the
upper part of the body from turning, then extend legs slowly
to first position. (5 times.)
3. Sitting — hands on hips. Bend body forward. Relax,
then circl'j to each side. (8-10 times each side.)
APPENDIX V
Scheme Number 1
Credit of 9 months. Period of training covers 2 years and 3 months (#7 months)
Service or Department. Month.
Preparatory 4
Medical 5
Surgical 5
Children '3
Maternity 3
Operating room.
Accident ward , . , 0 , , . . , ,,
^. , a choice of 3 months is given m any one of these _
Dispensary and . } 3
,, f , „ . services
Social Service or
Visiting Nursing
Night duty 2
Vacation 2
27
Scheme Number 2
Credit of 9 months. Period of training covers ffl months
Preparatory 4
Medical 4
Surgical 4
Children 4
Maternity 2
Contagious 3
Mental 3
Night Duty (to be included in above services)
Opeiating room If
Vacation If
Dispensary (students to be sent to dispensary in last months of various
services)
27
Scheme Number 8
Credit of 8 months. Period of training covers 28 months
Preparatory (including Diet School and surgical supply room) 4
Medical (including contagious services and 1 month's night duty) 6
173
174 APPENDIX V
Surgical (including operating room or accident ward, or surgical dispen-
sary and 1 month's night duty) 5
Children 4
Maternity 3
Social service or visiting nursing 2
Mental 2
Vacation 2
28
Scheme Number 4
Credit of full calendar year. Period of training covers 2J+ months
Preparatory 3
Medical 4
Surgical 4
Children 3
Maternity 3
Operating room or surgical dispensary, choice of 1^ months ^ „
Social service or medical or children's dispensary, choice of 1£ months. . /
Night duty 2
Vacation 2
24
APPENDIX VI
Hour Schedules from Hospitals in which an Eight Hour Day
is in Operation
No. 1 8 hour day
10 hour night
Day, 7.30 a.m. to 9.30 p.m 14 hours to cover
Night, 9.30 p.m. to 7.30 a.m 10 hours to cover
Hours on duty
a.m. p.m.
7.30 4
7.30-10.30 4-9.30
7.30-1 4-7.30
7.30-2.30 6-7.30
7.30-12 4-8
7.30-10.30 12.30-6 (occasionally)
$ hour allowed for meals
No. 2 8 hour ddy
10 hour night
Day, 7 a.m. to 9 p.m 14 hours to cover
Night, 9 p.m. to 7 a.m 10 hours to cover
Hours on duty
a.m. p.m.
7-9 1-7
7-1 7-9
7-1 5^-7
7-11 3-7
7-12 1-4
7-12 5-6 off 7-9
1 hour allowed for meals.
^ day on Sunday and usually on holidays.
No. 3 8-hour system.
Day, 7 a.m. to 11 p.m 16 hours to cover
Night, 11 p.m. to 7 a.m 8 hours to cover
Large ward of 60 patients, some in private rooms.
Hours on duty
1 senior
a.m.
7
p.m
to 3
1 intermediate
7
to 3
1 intermediate
7-12
3-7
1 Junior
7-11
4-7
1 junior
2 probationers
7-1
7-1
5-7
5-7
At S p.m.. a senior head-nurse comes on with 2 junior assistants who work
through until 11 p.m.
175
176 APPENDIX VI
At 11 p.m. a night head-nurse comes on with 2 juniors who take the floor
until the day nurses report.
In operating rooms, diet kitchens and contagious wards the
service is 10 hours with half-days.
Half-days also are given weekly and Sundays.
No. 4. 8-hour system three shifts
Day, 7 a.m. to 3 p.m 8 hours to cover
3. p.m. to 11 p.m 8 hours to cover
11. p.m. to 7.a.m 8 hours to cover
Hours on duty
a.m.. p.m.
7-1 4.30-7
7-10.30 2-7
7-2 5-7
7 3.30 off for day.
At 3 p.m. a night nurse comes on and stays until 11 p.m.
At 11 p.m.. another night nurse comes on and stays until 7 a.m.
From 7 a.m. a nurse may be on duty in accordance with needs
and off from 12 midnight to 4 a.m.
£ days off on holidays and Sundays.
1 hour for meals.
No. 5 8 hour day
12 hour night.
Day, 7 a.m. to 7 p.m 12 hours to cover
Night, 7 p.m. to 7 a.m 12 hours to cover
Ward. 30 beds.
4 students
Hours on duty
a.m.. p.m.
7-11 1-5
7-12 4-7
7-1 2-4
7-1 5-7
APPENDIX VII
Suggested Basis of Credit for Nursing Schools
A number of nursing schools are already connected with universities, and
many more are planning their work more or less on the credit basis of the
higher technical schools and colleges. Such a system makes it more possible
for other educational institutions to interpret and accredit the work done in
nursing schools and also provides a basis of comparison between the work of
one nursing school and another.
The system of credits used by most colleges and technical schools is on the
basis of the term's work1 — a term representing a period of approximately 15
weeks. For 1 hour of lecture or class per week during one term (or 15 hours),
the student would receive 1 point or 1 credit. (This would presuppose 2 hours
of outside preparation for every hour of class or lecture work.) About 2 to
3 hours of laboratory or class-room practice is usually credited as equal to 1
hour of regular class or lecture work.
On this basis the theoretical work of the nursing school could be evaluated
easily, the subjects covered in this curriculum amounting to about 36 points,
or one college year of work. It is much more difficult to arrive at a satisfactory
system of accrediting the practical work. Valuable as we feel this to be, we
cannot claim that it is of such intensive educational value, hour for hour, as
organized class or laboratory work which progresses steadily from one new
project to another and which is under constant supervision and criticism by
the teacher.
It must be understood that the work of vocational schools, such as music
or art schools, is not usually allowed full academic credit even in the most
liberal colleges. The maximum of academic credit .which would probably be
allowed for practical work of the type represented by nursing schools, would
be at the rate of from 1 to 1J points per month. There is no accepted basis
however for accrediting practical work.
It is suggested that nursing schools with university affiliations should ar-
range all their theoretical work on the credit basis. This would mean some
adjustment of the course of study as outlined here. All 10-hour courses should
be raised to 15 hours, so that they may qualify as 1-point courses; all 20-hour
courses should be raised to 30 hours (or where laboratory work is included, to
45 hours), to count as 2-point courses, etc. Examination periods would be in-
eluded in the 15 or 30 hours. This increase would mean 6 hours of class and
lecture work a week (after the first year), instead of 4 hours, which was con-
sidered the minimum for the average school. Several schools are already
working on this basis.
Many universities refuse to credit any courses of less than 30 hours or 2
points, hence it would be well where possible to combine two or more closely
related short courses into one which would represent at least two points
of credit.
177
I
JAN 2 1930
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MAY 1 1 1939
JAN 9 mi
JUL 5 1949
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JUL 2 6 194S
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